Abstract
We have previously reported that aldosteronism is related to body mass in men but not in women with resistant hypertension. The purpose of this study is to determine if severity of sleep apnea may contribute to this gender difference in patients with resistant hypertension. Consecutive subjects referred to the University of Alabama at Birmingham (UAB) Hypertension clinic for resistant hypertension were prospectively evaluated with an early morning plasma renin activity (PRA) and plasma aldosterone concentration (PAC). A 24-hour urine collection for aldosterone, sodium and creatinine was also obtained during an ad-lib diet. All subjects were on a stable antihypertensive regimen without use of potassium-sparing diuretics. All subjects were evaluated by full-night polysomnography at the UAB Sleep-Wake Disorders Center for the number of apnea-hypopnea events/hour, or the respiratory disturbance index (RDI). Biochemical assessment and polysomnography was performed on a total of 43 subjects (30 males and 13 females) with resistant hypertension. The RDI was positively and significantly correlated with urinary aldosterone levels (r=0.46, p=0.015) and PAC/PRA ratio (r=0.53, p=0.003) in male subjects. In contrast, RDI was not related to aldosterone excretion or the PAC/PRA ratio in female subjects. These results suggest that excess aldosterone excretion may be secondary to untreated sleep apnea in men with resistant hypertension. 
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© American Journal of Hypertension, Ltd. 2005
