Title:Relation Between Obstructive Sleep Apnea Syndrome and Resistant Hypertension - The Tip of the Iceberg
Volume: 11
Issue: 4
Author(s): Oana Claudia Deleanu, Ana-Maria Nebunoiu, Miruna Mihaela Micheu, Andra Elena Malaut and Florin Dumitru Mihaltan
Affiliation:
Keywords:
Arterial hypertension, blood pressure variability, continuous positive airway pressure, meta-analysis, obstructive
sleep apnea syndrome, resistant hypertension.
Abstract: Obstructive sleep apnea (OSA) and hypertension (HT) are widespread, sometimes
associated disorders that enhance each other and result in high morbidity and mortality rates. Resistant
hypertension (RHT) is a specific condition defined as high blood pressure that remains uncontrolled
despite treatment with at least three antihypertensive drugs (including a diuretic) at optimal doses.
Given that RHT is very common in OSA patients, OSA is now considered one of the leading causes of
RHT and RHT screening is mandatory in such cases. Some of the mechanisms seen in HT pathogenesis are also present
(with specific particularities) in the OSA-HT association. Thus, factors like increased sympathetic tone, renin-angiotensinaldosterone
system, endothelial dysfunction, vasoactive substances, inflammation, oxidative stress, nocturnal rostral fluid
shift and excessive daytime sleepiness add their burden to the pathological chain, leading to both resistance and nondipping
profile of HT. Consequently, we can assume that continuous positive airway pressure (CPAP) therapy in OSA
patients has an impact on HT and HT resistance. This review describes the effect of CPAP on the above-mentioned links
of the pathological chain, while providing information on new methods of assessing the cardiovascular risk in these
patients, a history of the most important studies on the OSA-RHT association and the outcomes of a recent meta-analysis
showing a positive effect of CPAP on 24-hour BP monitoring in patients with OSA and RHT compared to standard
antihypertensive treatment.
