Obstructive Sleep Apnea Is the Most Frequent Secondary Cause of Resistant Hypertension

Obstructive sleep apnea syndrome, continuous positive airway pressure and treatment of hypertension

“…In particular, an AHI ≥ 15 events/hour is present in 30% or more of patients with primary hypertension; in up to 80% of those with drug-resistant hypertension; in 30-60% of patients with ischemic heart disease; in 40-90% with cerebrovascular events; in 60% with newly diagnosed metabolic syndrome; in 40% with hypertrophic cardiomyopathy; in 12-50% of those with heart failure due to impaired systolic function; and in 40-60% of end-stage kidney disease patients treated with dialysis (19,20,23,27,28). Important, in the context of the present review, is the finding, by Pedrosa et al (29) amongst patients referred to their Sao Paolo clinic that OSA is the most common identifiable condition associated with resistant hypertension and one eminently amenable to treatment (30). These and related observations have sparked both investigation of an entirely new concept of hydrodynamic mechanisms that might be responsible for a bidirectional relationship between OSA and hypertension and other cardiovascular disease (23) and the direction of resources towards the evaluation of the clinical impact of OSA and of its abolition (20).…”

“…In a series of 125 Brazilian men and women diagnosed with resistant hypertension, OSA was detected in 64%. Older age, snoring and a large neck circumference, but not male sex, were significant predictors of OSA (29). However, it is improbable that all drug-resistant hypertension in patients with OSA is neurogenic in origin.…”

Hipertensión arterial y síndrome de apneas-hipoapneas del sueño en atención primaria

“…La existencia de cifras de PA similares en ambos grupos ya había sido descrita en estudios con un diseño similar 16 y podría deberse a que se trataba de pacientes hipertensos ya diagnosticados y con tratamiento antihipertensivo. Para conseguir estas cifras de PA similares, el doble de los pacientes del grupo casos precisaba consumir más de 2 hipotensores en comparación con los controles.…”

Consequences of obstructive sleep apnoea syndrome on left ventricular geometry and diastolic function

“…AHT in OSAS patients is more likely to affect diastolic BP in young people than systolic BP in the elderly [14]; typically, it has a non-dipper or a riser (higher sleep BP than awake BP) pattern [15][16][17][18] that leads to a higher frequency of masked hypertension (around 30% of cases) [19,20], and both of these conditions are known to be associated with even worse outcomes [21]. OSAS is also a recognized cause of resistant AHT [22,23], where the prevalence of OSAS exceeds 80% [24]. Potential confounding factors associated with both OSAS and AHT, such as age, diabetes mellitus and obesity, have been explored extensively, and are considered as independent but additive factors [4,7,8,14,25,26].…”