Journal of hypertension
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Journal of hypertension · Mar 2014
Effect of intensified diuretic therapy on overnight rostral fluid shift and obstructive sleep apnoea in patients with uncontrolled hypertension.
Fluid displacement from the lower extremities to the upper body during sleep is strongly associated with obstructive sleep apnoea in hypertensive patients. The present pathophysiological study tests the hypothesis that intensified diuretic therapy will reduce the apnoea-hypopnoea index and blood pressure of uncontrolled hypertensive patients with obstructive sleep apnoea in proportion to the reduction in overnight change in leg fluid volume. ⋯ The findings provide further evidence that fluid redistribution from the legs to the neck during sleep contributes to the severity of obstructive sleep apnoea in hypertension and may be an important link between these two conditions.
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Journal of hypertension · Mar 2014
A reduced heart rate variability is independently associated with a blunted nocturnal blood pressure fall in patients with resistant hypertension.
A blunted nocturnal blood pressure (BP) fall is a marker of worse cardiovascular outcomes, and autonomic imbalance may be involved. The objective was to evaluate the associations between the nocturnal BP fall and heart rate variability (HRV) parameters in resistant hypertension. ⋯ Reduced SDNN and SDANN, two HRV parameters that mainly reflect sympathetic overactivity, were independently associated with a blunted nocturnal BP fall in resistant hypertension. These relationships offer insight into physiopathological mechanisms linking the circadian BP variability to cardiovascular outcomes.
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Journal of hypertension · Mar 2014
Measurement of plasma renin concentration instead of plasma renin activity decreases the positive aldosterone-to-renin ratio tests in treated patients with essential hypertension.
The plasma aldosterone-to-renin ratio (ARR) for the diagnosis of primary aldosteronism is normally calculated with plasma renin activity (PRA) as denominator. However, new direct renin assays that measure plasma renin concentration (PRC) are progressively replacing PRA because these are faster, simpler, and more reproducible. ⋯ The rate of positive tests calculating ARR with PRC is lower than with PRA, the lower rate being found in patients studied in the recumbent position and apparently it is not affected by ongoing antihypertensive treatment.