The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

Objective. To determine the dynamics of the clinical and psychological characteristics on the background of 1 month of CPAP therapy in patients with obstructive sleep apnea syndrome (OSA) and arterial hypertension (AH), both adherent and non-adherent to the treatment. Methods. The study included 180 patients with OSA and AH. Upon enrollment, anthropometric data, the results of polysomnography and cardiorespiratory studies, Beck depression scale, Spielberger personal and situational anxiety scale, Epworth daytime sleepiness scale, Pittsburgh sleep quality questionnaire and Quality of Life (WHO QOL-100) questionnaire were analysed. Out of 40 patients undergoing CPAP therapy, 30 patients were adherent to the treatment within a month. The adherence criterion was considered to be the usage of the CPAP device more than 4 hours per night, more than 5 days a week. In this article, the dynamics of the questionnaire scales is given only for those who were adherent to CPAP therapy. Results. Patients with OSA and AH adherent to CPAP therapy showed a statistically significant reduction in daytime sleepiness and depression, as well as improved quality of sleep and quality of life in the physical domain within 1 month of using CPAP therapy. Conclusion. Even short-term use of CPAP therapy in patients with OSA and AH leads to a reduction in daytime sleepiness and depression, improved quality of sleep and quality of life in the physical domain.

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The combination of the obstructive sleep apnea (OSA) syndrome and arterial hypertension (AH) is a common problem affecting both the medical and social aspects of a patient's life. CPAP-therapy is the main treatment of sleep-discorded breathing. This paper focuses on up-to-date data on the relationship between OSA and AH and reviews studies evaluating the effect of CPAP-therapy on blood pressure, the risk of cardiovascular complications and the quality of life of patients.

Materials and methods. The study included 119 patients with obstructive sleep apnea (OSA) and cardiovascular diseases (CVD) who were followed up at the National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation in the period from 2012 to 2020, and have been receiving positive airway pressure (PAP) therapy (93 men, 78.2%). The median follow-up was 3.0 years [1.5; 5.0]. The adherence criteria were the following: the usage of the PAP device for at least 71% of nights a year, and at least 4 hours per night. Results. 64.3% of patients met the criteria for adherence to PAP therapy (use more than 4 hours/night, more than 71% of nights). The adherent patients were older (64.0 years [58.5; 68.0] versus 59.0 years [53.0; 65.0] resp., p=0.03) and had a higher apnea-hypopnea index AHI (47.7 events/h [37.5; 64.4] versus 38.2 events/h [30.4; 52.7] resp., p=0.04). Patients with stage III of hypertension were using a PAP device every night significantly less (3.4 h/night [1.1; 3.6] versus 6.3 h/night [5.3; 7.4] respectively, p=0.00) in comparison with patients with hypertension stages III. The adherence of patients with or without coronary artery disease (CAD) and paroxysmal atrial fibrillation (AF) did not differ. There was no significant difference in the incidence of stage III hypertension, CAD, and permanent AF between the groups of adherent and non-adherent to PAP therapy patients. Conclusion. 63.4% of patients with CVD were adherent to PAP therapy. Adherent patients were older and had a higher AHI. Patients with stage III hypertension were worse adherent to PAP therapy in comparison with patients with hypertension of lesser stages. The CVDs course in adherent and non-adherent patients did not differ.