HW 03-2 EFFECT OF CPAP ON THE TREATMENT OF RESISTANT HYPERTENSION

    loading  Checking for direct PDF access through Ovid

Abstract

Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the concurrent use of three antihypertensive agents of different classes at optimal dosing, of which one should be a diuretic. Accordingly, it is not synonymous with uncontrolled hypertension. Among a variety of risk factors, obstructive sleep apnea (OSA), which is a common type of sleep-disordered breathing, has been recognized a well-established risk factor for resistant hypertension. Indeed, both European and American guidelines for the management of arterial hypertension stated that OSA is a modifiable cause of resistant hypertension. Although the true incidence of resistance hypertension remains unknown, a significant portion of patients with resistant hypertension are thought to have OSA because of an increasing trend in the incidence of OSA worldwide. OSA is very common in hypertensive patients (up to 50%), and also difficult to reach the target blood pressure. According to The Sleep Heart Health Study, the patients with moderate to severe OSA had three times higher odds of having hypertension. In addition, because other large population-based studies have confirmed that OSA is a risk factor for resistant hypertension, a polysomnography examination (a sleep study) should be tested in patients with resistant hypertension. Even in some OSA patients, resistant hypertension could be the first sign without typical symptoms without a history of snoring, witnessed apnea, or excessive daytime sleepiness. The main pathologic mechanisms on how OSA contributes to the development of resistant hypertension include the downstream physiologic effects of recurrent hypoxia, endothelial dysfunction, autonomic nervous dysfunction, increased SNS activity, nocturnal fluid shifts, and overactivation of the renin-angiotensin system. These processes are directly and indirectly interrelated to the development of resistant hypertension. Although various treatment modalities for OSA in patients with resistant hypertension are being used, continuous positive airway pressure (CPAP) and life style modification in addition to antihypertensive medication are known to be very effective standard methods. Most of all, the effect of CPAP in patients with OSA and resistant hypertension has been demonstrated to have a significant benefit. Especially, better results with use of CPAP were observed in patients with severe OSA. Nevertheless, this standard is still challenging for some patients because of poor adherence, so new therapies including renal denervation and bariatric surgery are providing significant therapeutic benefits. In this talk, the effect of CAPA in patients with OSA and resistant hypertension will be discussed

Related Topics

    loading  Loading Related Articles