Nephrology Dialysis Transplantation, Vol 12, Issue 4 680-683, Copyright © 1997 by Oxford University Press
DS Silverberg, A Iaina and A Ocksenberg
For about 120 years we have been looking for the 'cause' of essential
hypertension. It is possible that we have merely been wandering through its
graveyard, looking at the pathogenetic mechanisms but never the actual
cause? Here we pass the gravestone of increased sympathetic activity; there
the gravestone of low renin activity. Here high endothelin; there low EDRF.
Here high thromboxane A2; there low prostacyclin. It is possible that all
these and so many other pathogenetic factors are all due to one basic
defect? Is it possible that, in the dead of night while patients with EH
have been sleeping, the villain has been lurking in their mouths, stuck
somewhere at the back of their throats, hidden from view yet choking them
hundreds of times a night. But this intermittent strangulation has not
occurred silently. On the contrary, it has made its presence felt in the
most irritating way, with snores, groans, grunts, gasps and frightening
periods of total apnea. But we, their physicians, never asked about these
symptoms, or, if we did, we never paid heed to them. This is clear from the
fact that, most cases of OSA occur in association with EH yet are not
diagnosed. Perhaps the next 'arousal response' should be the arousal of
physicians' consciousness so that they can at long last wake up to the
existence of the close connection between sleep-related breathing disorders
and hypertension and breathe some new life into the treatment of two old
diseases-essential hypertension and secondary hypertension. Early diagnosis
and treatment of the sleep-related breathing disorders may not only make
the patient feel much better, (something our antihypertensive medications
do not always do), but may reduce the blood pressure and prevent the
progression of renal and cardiovascular damage as well.
REVIEWS
Sleep-related breathing disturbances: their pathogenesis and potential interest to the nephrologist
Department of Nephrology, Tel Aviv Medical Center, Israel.
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