Abstract
Hypertension is one of the most frequent cardiovascular risk factors. The population of hypertensive patients includes some phenotypes whose blood pressure levels are particularly difficult to control, thus putting them at greater cardiovascular risk. This is especially true of so-called resistant hypertension (RH) and refractory hypertension (RfH). Recent findings suggest that the former may be due to an alteration in the renin–angiotensin–aldosterone axis, while the latter seems to be more closely related to sympathetic hyper-activation. Both these pathophysiological mechanisms are also activated in patients with obstructive sleep apnoea (OSA). It is not surprising, therefore, that the prevalence of OSA in RH and RfH patients is very high (as reflected in several studies) and that treatment with continuous positive airway pressure (CPAP) manages to reduce blood pressure levels in a clinically significant way in both these groups of hypertensive patients. It is therefore necessary to incorporate into the multidimensional treatment of patients with RH and RfH (changes in lifestyle, control of obesity and drug treatment) a study of the possible existence of OSA, as this is a potentially treatable disease. There are many questions that remain to be answered, especially regarding the ideal combination of treatment in patients with RH/RfH and OSA (drugs, renal denervation, CPAP treatment) and patients’ varying response to CPAP treatment.
Highlights
Hypertension is one of the most common modifiable risk factors for the development of cardiovascular disease and mortality
resistant hypertension (RH) was defined in the first American Heart Association (AHA) statement as those forms of hypertension with no identifiable cause in which blood pressure (BP) levels remain uncontrolled despite the use of at least three antihypertensive drugs prescribed at optimal doses or are controlled only by treatment with four or more antihypertensive drugs [18]
* This study investigate the association between Obstructive sleep apnoea (OSA) and refractory hypertension
Summary
Hypertension is one of the most common modifiable risk factors for the development of cardiovascular disease and mortality. This identification is essential, in the light of the high cardiovascular impact of RH and RfH, as they are associated with a 50% higher probability of developing a cardiovascular event or damage to target organs than controlled hypertensive patients [5]. It has been demonstrated that OSA treatment with continuous positive airway pressure (CPAP) reduces BP by around 2–2.5 mmHg in patients with hypertension and by up to 5 mmHg in those with RH [17]. All this evidence suggests that OSA and its treatment may play an important role in RH. We will cover the different aspects of the relationship between RH and OSA, including the epidemiology of RH and RfH, the clinical association with OSA, the pathophysiological links between the two disorders and the different therapies for RH and RfH (with a special focus on OSA treatment), as well as potential future challenges in the interactions between OSA and RH
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