PP.28.25] YOUNG REVERSE DIPPER HYPERTENSION

Abstract

Objective: To describe 2 cases of reverse dipper hypertension Design and method: Obstructive sleep apnea (OSA) is a recognized cause of secondary hypertension and is associated with increased cardiovascular morbidity and mortality. Recurrent episodes of apnea result in hypoxia and hypercapnia increasing sympathetic tone, oxidative stress, inflammation and endothelial dysfunction leading to persistent elevation of blood pressure, a phenomenon described as non-dipping. We described 2 cases of OSA in young reverse dipper hypertensives. Case Report 1. An 18 years old Chinese female, BMI 37, non-smoker, non-alcoholic, non-diabetic, pre-hypertensive, with familial history of Hypertension (HTN) with suspected OSA was evaluated Case Report 2. A 34 years old Malay, BMI 30, non-smoker, non-alcoholic, non-diabetic with familial history of cardiovascular diseases. She presented with hypertension stage 2 with snoring and day time sleepiness. Results: Case Report 1: Investigations and Laboratory Work-up: Epworth Sleepiness Scale score of 14. Polysomnography showed moderate OSA, worse in REM, Apnea Hypopnea Index 15.1. Ambulatory Blood Pressure Monitoring showed reverse dipper pattern. Other tests were normal. Progress: She was evaluated by Endocrinologist for obesity and Pulmonologist for OSA. She was advised on weight, dietary and lifestyle modifications. In view of borderline hypertension, CPAP was recommended. CPAP was initiated but patient was non-compliant. On follow up visits with General Medicine clinic, hypertension remained uncontrolled. Case Report 2: Investigations and work-up: Renal Doppler ultrasound showed no renal artery stenosis. Ambulatory Blood Pressure Monitoring showed reverse dipper pattern. Other test were unremarkable. Progress: Blood pressure remained controlled on Amlodipine and lifestyle modification and weight reduction. Conclusions: Young patients with reverse dipper pattern of hypertension should be screened for OSA to reduce risk for cardiovascular events.