An overlooked cause of resistant hypertension: upper airway resistance syndrome - preliminary results

OBJECTIVE: Upper airway resistance syndrome is a sleep-disordered breathing syndrome that is characterized by repetitive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome was associated with poorly controlled hypertension. METHODS: A total of 40 patients with resistant hypertension were enrolled in the study. All of the patients underwent polysomnographic examinations and 24-hour ambulatory blood pressure monitoring to exclude white coat syndrome and to monitor treatment efficiency. Among 14 upper airway resistance syndrome patients, 2 patients had surgically correctable upper airway pathologies, while 12 patients were given positive airway pressure therapy. RESULTS: All patients underwent polysomnographic examinations; 22 patients (55%) were diagnosed with obstructive sleep apnea and 14 patients (35%) were diagnosed with upper airway resistance syndrome, according to American Sleep Disorders Association criteria. The patients with upper airway resistance syndrome were younger and had a lower body mass index compared with other patients, while there were no difference between the blood pressure levels and the number of antihypertensive drugs. The arousal index was positively correlated with systolic blood pressure level (p = 0.034; rs = 0.746), while the Epworth score and AHI were independent of disease severity (p = 0.435, rs = 0.323 and p = 0.819, rs = -0.097, respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all of them, whereas no pressure reduction was observed in four untreated patients. CONCLUSIONS: We conclude that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and that its proper treatment could result in dramatic blood pressure control

Role of serum hdl level and HDL functions on progression of calcific aortic stenosis

Kalsifik aort kapak darlığı kan akımına engel oluşturmayan hafif kapak kalınlaşmasından; aort sklerozu, ciddi kapak kalsifikasyonu ve eşlik eden yaprakçık hareket kısıtlılığına kadar devamlılık gösteren ilerleyici bir süreçtir. Klinik ve epidemiyolojik çalışmalar ateroskleroz risk faktörlerinin aort darlığı gelişimi ve ilerlemesinde rolü olduğunu göstermiştir. Özellikle lipoprotein metabolizması bozukluklarının, yüksek total kolesterol ve yüksek LDL düzeylerinin, patogenezdeki rolüne ait güçlü histopatolojik kanıtlar bulunmaktadır. Ancak HDL partikülünün bu mekanizmadaki yeri henüz net değildir. Çalışmalar aort darlığı progresyonu ile düşük HDL seviyeleri arasındaki ilişkiyi göstermiş olmakla birlikte mevcut literatür tarandığında bu grupta HDL fonksiyonlarını inceleyen bir araştırmaya rastlanmamıştır. Bu grupta HDL-kalsifik aort darlığı ilişkisini detaylandırabilmek için hafif orta kalsifik aort darlığı ile takip edilen toplam 42 hastada (26 kadın, 16 erkek) serum HDL düzeyleri, HDL alt grupları, apolipoprotein AI düzeyi ve HDL ilişkili enzimler olan plazma PON1 ve PAF-AH aktiviteleri belirlendi ve bunların hastalık ilerlemesiyle olan ilişkisi değerlendirildi. Darlık ilerleme hızının serum LDL düzeyi ile pozitif korelasyon gösterirken HDL düzeyi ile negatif korelasyon sergilediği tespit edildi. HDL altgruplarından HDL2 ile progresyon arasında anlamlı pozitif ilişki saptandı. Serum apolipoprotein A1 düzeyinin hastalık ilerlemesinden bağımsız görünmekle birlikte HDL2 ile negatif korelasyon sergilediği görüldü. HDL3 ün progresyonla olan pozitif ilişkisi istatistiki anlamlılığa ulaşmadı. HDL ilişkili enzimlerden olan PON1 aktivitesi progresyon ile anlamlı negatif ilişki içerisindeyken HDL ilişkili PAF-AH aktivitesi ilerleme ile korelasyon göstermedi.Calcific aortic stenosis is a disease continuum ranging from mild valve thickening to impaired leaflet mobility with extensive calcification. Clinical and epidemiological data well defines the role of atherosclerotic risk factors in pathogenesis of aort stenosis. Especially dyslipidemia with elevated total and LDL cholesterol levels exerts certain histopathological changes on calcified valve tissue. Low HDL levels were also demonstrated as a risk factor yet the exact role of HDL in this process is unkown. In an effort to evaluate calcific aortic stenosis-HDL relationship 42 patients (26 female; 16 male) with mild to moderate isolated aortic valve stenosis were evaluated in terms of demographic features; progression rates, serum lipid profiles with special focus on HDL; HDL subspecies, serum apoA1 levels and HDL related PON1 and PAF-AH enzyme activities. Progression rates were found to be positively correlated with serum LDL levels while negatively correlated with serum HDL levels. HDL2 subset demonstrated positive correlation with progression while HDL3 and serum apoA1 levels were independent of disease progression. A strong negative relationship was documented betweeen HDL2 AND apoA1. Among HDL related enzymes serum PON1 activity declines as stenosis progresses. No correlation between PAF-AH activity and progression was documented

An overlooked cause of resistant hypertension: upper airway resistance syndrome - preliminary results

OBJECTIVE: Upper airway resistance syndrome is a sleep-disordered breathing syndrome that is characterized by repetitive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome was associated with poorly controlled hypertension. METHODS: A total of 40 patients with resistant hypertension were enrolled in the study. All of the patients underwent polysomnographic examinations and 24-hour ambulatory blood pressure monitoring to exclude white coat syndrome and to monitor treatment efficiency. Among 14 upper airway resistance syndrome patients, 2 patients had surgically correctable upper airway pathologies, while 12 patients were given positive airway pressure therapy. RESULTS: All patients underwent polysomnographic examinations; 22 patients (55%) were diagnosed with obstructive sleep apnea and 14 patients (35%) were diagnosed with upper airway resistance syndrome, according to American Sleep Disorders Association criteria. The patients with upper airway resistance syndrome were younger and had a lower body mass index compared with other patients, while there were no difference between the blood pressure levels and the number of antihypertensive drugs. The arousal index was positively correlated with systolic blood pressure level (p = 0.034; rs = 0.746), while the Epworth score and AHI were independent of disease severity (p = 0.435, rs = 0.323 and p = 0.819, rs = -0.097, respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all of them, whereas no pressure reduction was observed in four untreated patients. CONCLUSIONS: We conclude that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and that its proper treatment could result in dramatic blood pressure control

Role of serum high density lipoprotein levels and functions in calcific aortic valve stenosis progression.

Clinical and epidemiological data well defines the role of atherosclerotic risk factors in pathogenesis of aortic stenosis. Especially dyslipidemia with elevated total and LDL cholesterol levels exerts certain histopathological changes on calcified valve tissue. Exact role of HDL in this process is not known