Acute Blood Pressure Elevation Research Articles

Use of Near Infrared Transillumination / Back Scattering Sounding (NIR-T/BSS) to assess effects of elevated intracranial pressure on width of subarachnoid space and cerebrovascular pulsation in animals.

The objective was to assess changes in the width of the subarachnoid space (SAS) and amplitude of cerebrovascular pulsation (CVP) during acute elevation of intracranial pressure (ICP) using Near Infrared Transillumination/Back Scattering Sounding (NIR-T/BSS). Changes in the width of the SAS and amplitude of CVP were observed in rabbits during experimental ICP elevation induced by: (1) quick injections of saline into the subdural space of the spinal cord, and (2) distension of a surgical catheter balloon placed intracranially in the subdural space. The amplitude of CVP was also assessed during acute elevation of blood pressure in the intracranial portion of the internal carotid artery (ICA) induced by adrenaline. Each of the injections of saline caused a transient rise in the width of the SAS and amplitude of CVP. The amplitude of the increase in CVP was dependent on changes in blood pressure in the ICA (r=-0.82, P<0.01). Distension of the intracranial balloon resulted in elimination of the respiratory oscillations in the CVP and increased its systolic-diastolic amplitude. An increase in the amplitude of CVP was evoked by adrenaline without an increase in the carotid blood flow. We demonstrated that during elevation of ICP the amplitude of CVP depends on blood pressure rather than on blood flow in large cerebral vessels. Elimination of the respiratory oscillations by a minute ("sub-critical") ICP increase may be used as an early indicator of rising ICP. The direction of changes recorded using NIR-T/BSS was consistent with changes recorded using tensometric transducers.

Cerebral blood flow measurement following extreme blood pressure reduction in an acute intracerebral hemorrhage patient

Acute blood pressure (BP) elevation is very common after ICH nd is associated with poor outcome. There is some evidence that ematoma growth is correlated with higher systolic BP and that arly treatment may prevent further expansion [1]. However, acute P reduction also carries a theoretical risk of induction or exaceration of perihematomal ischemia. There are therefore opposing ationales for acute BP management, which have resulted in conervative treatment guidelines. We describe a case in which we tilized CT perfusion (CTP) to acutely measure cerebral blood flow CBF) in an ICH patient following a precipitous fall in BP.

Modifications of the ABCD2 Score Do Not Improve the Risk Stratification of Transient Ischemic Attack Patients

Modifications to the age, blood pressure, clinical symptoms, duration of symptoms, and diabetes (ABCD2) score, which incorporate history of hypertension and acute hyperglycemia in addition to acute blood pressure (BP) elevation and history of diabetes, have been proposed to increase the predictive value of the score. In addition, the timing of acute BP measurement may be important in the emergency department (ED) setting, given the phenomenon of "ED triage hypertension". The standard ABCD2 score was compared to modified scores incorporating various combinations of acute BP elevation or hyperglycemia, history of hypertension or diabetes, and subsequent versus initial ED BP measurements. The number of patients reclassified into an alternate risk category (low/moderate/high) with different schemes was determined. Predictive value using the composite outcome of stroke, death, or high-risk transient ischemic attack mechanism was assessed using c statistics. Modified ABCD2 scores resulted in few patients shifting risk categories (between 2% and 10% for six alternate schemes), and did not improve the performance of the ABCD2 score (c-statistics, 0.61-0.65, compared to 0.63 for the standard score). ED triage hypertension was frequent (mean systolic blood pressure [SBP]/diastolic blood pressure [DBP] decrease of 8/9 mm Hg on subsequent measurement; P < .001), but the use of second BP did not reclassify many patients (10%) nor did it improve score performance (c-statistic, 0.61). Modifications of the ABCD2 score changed the risk category for few patients and did not improve the overall predictive value of the score.

Comparison of alprazolam versus captopril in high blood pressure: A randomized controlled trial

Objective. Anxiety is an important cause of acute blood pressure (BP) elevation. However, the role of anxiolysis in this situation is still controversial. In this study, the relationship of anxiety with BP and the effect of anxiolytic treatment on BP were investigated. Methods. Emergency department (ED) patients with an initial systolic BP (SBP) ≥ 160 mmHg or diastolic BP (DBP) ≥ 100 mmHg but no end organ damage were approached for inclusion in the study. In those consenting to participate, anxiety levels were measured using the State-Trait Anxiety Index (STAI) and Visual Analog Scale for Anxiety (VAS-A). Patients were randomly assigned to receive oral alprazolam 0.5 mg or captopril 25 mg. BP and anxiety levels were measured at baseline and at 1 and 2 h after administration of the study medication. Results. Of 133 patients meeting inclusion criteria, 53 patients agreed to participate. Of these, 27 patients (50.9%) received captopril and 26 patients (49.1%) received alprazolam. The majority of the patients had a high-level trait (96.2%, n = 51) and state anxiety (81.1%, n = 43). The mean SBP and VAS-A values of both patient groups dropped significantly over the 2 h, with no significant difference between the two groups. A significant association between SBP and VAS-A scores was found (F(2,50) = 6.27, p = 0.004). Conclusion: A significant association exists between the level of BP and anxiety in hypertensive ED patients. Alprazolam is as effective as captopril in lowering BP in ED patients with an initial SBP > 160 mmHg.

The optometrist’s role in the management of hypertensive crises

Background In hypertensive crises, ocular findings are pivotal to making correct management decisions. Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC-7) guidelines define hypertensive crises as blood pressure greater than 180/120 mmHg associated with signs or symptoms of target organ damage. Urgent cases are those without optic disc edema but that necessitate control within 24 to 72 hours. Emergent cases are those with optic disc edema, also known as malignant hypertension, demanding control within 1 to 6 hours. Case Reports Two cases are illustrated, as might be seen in optometric offices, of severe stage II hypertension. In case 1, the acute elevation of blood pressure (220/110 mmHg), was assessed as an urgent case and was correctly managed with the primary care provider through outpatient care. The second case of acute elevation of blood pressure (250/150 mmHg) and ocular findings of severe hypertensive retinopathy was sent as an emergent case to the emergency room. Conclusion These cases exemplify optometric in-office decisions to effectively manage urgent and emergent cases of hypertensive crises. Utilizing an urgent versus emergent classification of retinopathy can lead to the appropriate management decision for these patients.

Hypertensive crisis: clinical–epidemiological profile

Hypertensive crisis (HC) stands out as one type of acute elevation in blood pressure (BP) and can manifest as hypertensive emergency (HE-with target-organ damage (TOD)) or hypertensive urgency (HU-without TOD), usually accompanied by levels of diastolic BP ≥120 mmHg. The aim of this study was to characterize the clinical-epidemiological profile of HC over the course of 1 year in a university reference hospital and perform a review of the literature. The study was a cross-sectional study, conducted over a period of 1 year (2006) in 362 patients who presented for treatment at the emergency hospital with HC, as described above. Among all patients examined, 231 individuals met the criteria for HE and 131 met the criteria for HU. Patients with HE were older (P<0.001) and more sedentary (P=0.026) than those with HU. Furthermore, fewer HE patients than HU patients had previously undergone antihypertensive treatment (P=0.006). The groups did not differ regarding BP levels, gender, smoking or body mass index. Dyspnea (41.1%), thoracic pain (37.2%) and neurological deficit (27.2%) were common signs/symptoms in those with HE. Meanwhile, in the group with HU, we most frequently found headache (42.0%), thoracic pain (41.2%) and dyspnea (34.3%). Among the forms of HE, we most frequently observed acute lung edema (30.7%), myocardial infarction/unstable angina (25.1%), and ischemic (22.9%) and hemorrhagic (14.8%) stroke. HC is a clinical entity associated with high morbidity in the emergency room. Individuals with HE are older and sedentary and have lower rates of antihypertensive treatment. Adequate control of BP should be pursued as a way to avoid this severe complication of hypertension.

NADPH Oxidase 2 Mediates Intermittent Hypoxia-Induced Mitochondrial Complex I Inhibition: Relevance to Blood Pressure Changes in Rats

Previous studies identified NADPH oxidases (Nox) and mitochondrial electron transport chain at complex I as major cellular sources of reactive oxygen species (ROS) mediating systemic and cellular responses to intermittent hypoxia (IH). In the present study, we investigated potential interactions between Nox and the mitochondrial complex I and assessed the contribution of mitochondrial ROS in IH-evoked elevation in blood pressure. IH treatment led to stimulus-dependent activation of Nox and inhibition of complex I activity in rat pheochromocytoma (PC)12 cells. After re-oxygenation, Nox activity returned to baseline values within 3 h, whereas the complex I activity remained downregulated even after 24 h. IH-induced complex I inhibition was prevented by Nox inhibitors, Nox2 but not Nox 4 siRNA, in cell cultures and was absent in gp91(phox-/Y) (Nox2 knock-out; KO) mice. Using pharmacological inhibitors, we show that ROS generated by Nox activation mobilizes Ca(2+) flux from the cytosol to mitochondria, leading to S-glutathionylation of 75- and 50-kDa proteins of the complex I and inhibition of complex I activity, which results in elevated mitochondrial ROS. Systemic administration of mito-tempol prevented the sustained but not the acute elevations of blood pressure in IH-treated rats, suggesting that mitochondrial-derived ROS contribute to sustained elevation of blood pressure.

Efficacy of Clevidipine in Controlling Perioperative Hypertension in Neurosurgical Patients

Acute blood pressure (BP) elevations in neurosurgical patients are associated with serious neurologic, cardiovascular, or surgical site complications. Clevidipine, an ultra-short-acting dihydropyridine calcium antagonist, has been shown to be efficacious and safe for acute hypertension in cardiac surgery. This study assessed the efficacy and safety of clevidipine in controlling perioperative hypertension in the neurosurgical setting. Patients scheduled for intracranial surgery were prospectively enrolled after giving consent. Clevidipine (0.5 mg/mL in 20% lipid solution, which was to be initiated at 10 mg/h and titrated to effect) was administered as the primary antihypertensive agent for perioperative hypertension, with target BPs of less than 130 mm Hg. Other vasoactive drugs were administered as needed for treating systolic BP (SBP) less than 90 mm Hg or greater than 130 mm Hg. The primary study endpoint was the proportion of patients not requiring rescue antihypertensives to maintain target SBP (<130 mm Hg). Twenty-two patients were enrolled. One patient did not require antihypertensive therapy. Seventeen patients (17 of 21, 81%) were treated with clevidipine alone; one received clevidipine in the postanesthesia care unit only. Twenty-eight hypertensive episodes (defined as any new acute BP elevation requiring clevidipine initiation) were documented. SBP was reduced to target level within 15 minutes in 22 of 28 episodes (78.6%). Two mild hypotensive episodes occurred after the initiation of clevidipine infusion; these transient decreases in BP were treated with vasoactive drugs and resolved within 5 minutes. Clevidipine is effective and safe for perioperative hypertension in patients undergoing intracranial procedures. Rapid control of BP is possible with higher starting doses. Drug effects resolved rapidly after drug discontinuation.

The Clinical and Radiological Spectrum of Posterior Reversible Encephalopathy Syndrome: A Retrospective Series of 24 Patients

Some patients with posterior reversible encephalopathy syndrome (PRES) present with atypical clinical and neuroimaging findings. The purpose of this study is to review the clinical and neuroimaging findings in patients diagnosed with PRES. We retrospectively included all patients diagnosed with PRES between January 2005 and March 2009. We reviewed demographic, clinical and laboratory data, neuroimaging findings, and prognosis. Twenty-four patients were included with a median age of 19 years. The clinical presentations included seizures (91.7%), headache (83.3%), visual disturbance (62.5%), encephalophathy (29.2%), and paralysis (8.3%). Co-morbidities included systemic lupus erythematous (29.2%), kidney disease (20.8%), eclampsia (20.8%), renal artery stenosis (12.5%), Takayasu arteritis (4.2%), Sheehan's syndrome (4.2%), allergic purpura (4.2%), and acute intermittent porphyria (4.2%). Acute elevation of blood pressure was found in 22 patients (91.7%). Ten patients (41.7%) used steroids or immunosuppressants, three (12.5%) had acute renal failure before the symptoms. Atypical neuroimaging features included involvement of the frontal lobe (54.2%), basal ganglia (4.2%) or cortex (8.3%), and irreversible lesions (3/18, 16.7%). A large proportion of patients with PRES may present with atypical neuroimaging findings. Apart from the known risk factors, such as hypertension, immunosuppressants, and renal failure of various etiologies may be the precipitants of PRES.

A CASE OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN A CHILD WITH MYELODYSPLASTIC SYNDROME FOLLOWING ALLOGENIC BONE MARROW TRANSPLANTATION

Posterior reversible encephalopathy syndrome (PRES) is an uncommon but distinctive clinical–radiologic entity characterized by headache, seizures, visual disturbance, and altered mental function associated with reversible white matter edema affecting the posterior parietal and occipital lobes of the brain. Although PRES is caused by a variety of conditions, acute elevation of blood pressure, fluid retention, and treatment with immunosuppressive drugs and/or anti-neoplastic agents are the main causes. A few cases of PRES associated with hematopoietic stem cell transplantation (HSCT) in children have been reported. Early recognition of PRES and appropriate management are needed to reduce the risk of permanent neurologic disability. The authors report a case of PRES in a girl who received an HLA-identical sibling bone marrow transplantation for myelodysplastic syndrome to emphasize the importance of early recognition and institution of appropriate management of PRES during HSCT.

Renal Sympathetic Nerve Ablation: The New Frontier in the Treatment of Hypertension

The sympathetic nervous system plays an important role in circulatory and metabolic control and has clearly been established as a major contributor to the development of hypertension, as elevated sympathetic nerve activity initiates and sustains the elevation of blood pressure. Increased sympathetic outflow to the heart, resulting in increased cardiac output and neurally mediated vasoconstriction of peripheral blood vessels, is an obvious example of a neural pathophysiologic pathway leading to elevated blood pressure. The consequences of increased sympathetic outflow to the kidneys, perhaps most important in this context, are sodium and water retention, increased renin release, and alterations of renal blood flow-effects that contribute substantially to both acute and long-term blood pressure elevations. Accordingly, renal sympathetic nerve ablation appears to be a logical therapeutic approach for the treatment of hypertension. Recent reports on a novel catheter-based renal nerve ablation procedure reviewed in this article are promising.

Treatment of Hypertension in the Inpatient Setting: Use of Intravenous Labetalol and Hydralazine

Acute blood pressure elevations are commonly treated in hospitalized patients. There are no guidelines for appropriate practice and no evidence that such treatment is useful. The authors performed a retrospective review of medical and pharmacy records to determine how often intravenous hydralazine and labetalol are ordered and administered. During a 1-year study period, a total of 29,545 hospitalizations were recorded. The authors identified 2189 patients (7.4% of all patients) for whom 7242 orders were written for hydralazine as needed (10-20 mg per dose) and 5915 for labetalol (10-20 mg per dose). Ordered drugs were administered in 60.3% of patients, and the average number of doses administered was 5.3+/-8.2 (mean +/- SD) for hydralazine and 5.6+/-7.7 for labetalol. Hospital length of stay (LOS) for patients for whom hydralazine was ordered was 12.0+/-15.9 days for those who received at least 1 dose and 7.1+/-9.0 days for those who did not receive a dose (P<.001). For patients for whom labetalol was ordered, patients receiving at least 1 dose had an LOS of 11.8+/-16.1 days vs 7.9+/-10.4 days for those who did not receive a dose (P<.001). Treatment of elevated blood pressure in in-patients is a common practice. The authors suggest that evidence is needed to determine whether the practice is of benefit.

Transcranial Evaluation of Blood Flow Velocity in the Basilar Artery in Rats by High Frequency Ultrasonic Doppler Technique

The possibility of recording the blood flow velocity in the basilar artery (a. basilaris) in rats through the occipital membrane by a two-channel ultrasonic Doppler system with single-element transducers was demonstrated. A. basilaris was located with a contact transducer working at a frequency of 33 MHz in two modes: pulsed and permanent. The mean blood flow velocity in narcotized male Wistar rats was 4.93+/-0.78 cm/sec. Functional loading tests (acute elevation of blood pressure and occlusion of the common carotid arteries) showed that this method allows recording dynamic characteristics of the blood flow reactions in a. basilaris with evaluation of its pulse wave pattern and analyzing their correlations with blood flow parameters in the carotid arteries using simultaneously the second (bandage) transducer.

Blood Pressure Management in Acute Intracerebral Hemorrhage

Primary intracerebral hemorrhage (ICH) results from spontaneous rupture of an intracranial vessel and is associated with high rates of early mortality and long-term morbidity. No surgical or medical intervention has been demonstrated to improve outcome. Acute blood pressure elevation is seen in the majority of patients with ICH and is correlated with poor outcome. Potential, but unproven, mechanisms for this association include facilitation of hematoma expansion as well as perihematomal edema growth. Conversely, the perihematomal region has also been hypothesized to have ischemic properties. Therefore, management of blood pressure in the acute phase lends itself to two competing rationales and the optimal target blood pressure remains unknown. A number of parenchymal and blood-flow imaging techniques have been utilized to improve our understanding of blood flow and metabolism in acute ICH. These studies generally indicate that ischemia is not a major pathophysiological mechanism of secondary injury in ICH. Ultimately, randomized, controlled trials, which are underway, will be required to definitively determine the safety and efficacy of acute blood pressure reduction. It appears most likely that earlier and more aggressive treatment of acute blood pressure will be recommended in the future.

A New Intravenous Calcium Channel Blocker Option to Treat Acute Elevations in Blood Pressure

Intravenous (IV) agents are needed to treat acute elevations in blood pressure (BP) in a number of different clinical settings including in the emergency department, perioperatively, and during hypertensive crises in the intensive care unit. IV agents are often needed to maintain BP within a narrow target range and many of the existing agents have a prolonged half-life, with overshooting of BP goals occurring frequently. IV agents available up to now have included a number of different agents with various advantages and adverse effects. For more than a decade, only one IV dihydropyridine calcium channel blocker (CCB), nicardipine, has been available for IV use for treatment of hypertension. Issues with IV dihydropyridine CCB delivery in the past include poor water solubility of this class and the reduction of pH in the 3.7 to 4.7 range with IV nicardipine, which may be part of the reason why changing the peripheral IV site every 12 hours is recommended in the package insert. Nicardipine is a second-generation IV dihydropyridine CCB. It is an effective antihypertensive; however, its major limitation is a longer half-life that precludes rapid titration. Its onset of action is within 10 to 15 minutes and its duration of action is 15 to 30 minutes but may exceed 4 hours. Clevidipine is a new third-generation IV dihydropyridine CCB that was recently approved by the US Food and Drug Administration in 2008 for treatment of severe hypertension. It reduces BP without affecting cardiac filling pressures or causing reflex tachycardia.1,2 The main advantage of this drug is that it has an ultra-short half-life of <1 minute.3 It exerts a rapid and titratable arterial BP reduction with fast termination of effect. It is an arterial selective vasodilator that reduces peripheral vascular resistance directly without causing venous capacitance dilation.4 BP reductions occur within 6 to 10 minutes and BP and heart rate return to baseline within 10 to 15 minutes after discontinuation of the drug. Rapid elimination of the drug is maintained after stopping either a long (24-hour) or short infusion.5 Clevidipine incorporates an easily hydrolyzable ester group into its chemical structure and, as a result, clevidipine is rapidly metabolized by the blood and tissue esterases independent of liver and kidney function.6 Esterase-based metabolism may also partially account for the lack of drug toxicity and little to no risk of cytochrome P450–associated drug toxicity.7 Clevidipine does result in a modest increase in heart rate from baseline, as has been shown with other IV CCB agents. Heart rate increases within the first 30 minutes of administration, but this appears to decrease back to baseline.8 The drug has been shown to be well tolerated without an increase in adverse side effects compared with placebo. Initial studies showed a slight increase in atrial fibrillation, but this has not been reproduced in subsequent studies. Clevidipine represents a new IV option for acute reduction in BP with an ultrashort half-life, therefore reducing the risk of overshooting BP targets.9 It has been shown in various studies to be effective in producing acute reductions in BP in the emergency department9 and perioperatively in cardiac surgery where maintenance of a narrow range of BP is required.1,10

Clevidipine

Hypertension is the most common cardiovascular condition in the United States. It can lead to end organ damage and increased mortality risk if it is not properly controlled. In most situations where blood pressure has to be brought down quickly, an intravenous agent with a quick onset of action is often used. Clevidipine is the first third-generation IV dihydropyridine calcium channel blocker that has a high degree of vascular selectivity and an ultra-fast onset and offset of blood pressure lowering effect. In various clinical trials, clevidipine has shown to be safe and effective in controlling acute blood pressure elevations in patients with hypertensive emergencies, preoperative hypertension, and postoperative hypertension. The most common adverse events noted are atrial fibrillation, nausea, headache, and acute renal failure. Overall, clevidipine is a useful addition to available intravenous agents in reducing blood pressure during acute situations. The acceptance of this agent to hospital formularies may ultimately depend on its perceived ease of administration, clinically relevant benefits over other available agents, and acquisition costs.

Management of Hypertension in the Acute Phase of Stroke

An increase in arterial blood pressure (BP) is common following the onset of stroke. Although there is evidence suggesting that this acute elevation of BP is associated with a poor clinical outcome in both ischemic and hemorrhagic stroke patients, optimal treatment strategies are currently unknown. The management of BP in the first 24 hours following stroke lends itself to two competing rationales in both stroke sub-types. In ischemic stroke patients, BP reduction may improve outcome, potentially by reducing hemorrhagic transformation and edema formation. Conversely, antihypertensive therapy may also reduce cerebral blood flow (CBF) in the penumbra, exacerbating ischemic injury. Similarly, BP reduction may improve outcome in hemorrhagic stroke patients by preventing the expansion of the hematoma and reducing perihematoma edema. The perihematoma region has also been hypothesized to have ischemic penumbral properties, although the evidence for this is limited. Nonetheless, there is the potential for detrimental CBF compromise following BP reduction in hemorrhagic stroke as well. Recently, advanced neuro-imaging techniques have made it possible to test many of the hypotheses related to the etiology of BP elevation and optimal treatment strategies in acute stroke. This article summarizes concepts and evidence for different BP management strategies in both types of stroke. Keywords: blood pressure (BP), hemorrhagic stroke, ischemic stroke, cerebral blood flow (CBF), neuro-imaging techniques

Considerations in the diagnosis and therapy for acute loin pain

The clinical presentation of acute onset of nausea, vomiting, and flank pain in combination with acute elevation of blood pressure should raise high suspicion of renal infarction. However, because of its nonspecific presentation, diagnosis may be delayed. We report the case of a 63-year-old man who presented with a 2-day history of right flank pain that was treated initially as a renal stone. He had a background history of atrial fibrillation. Further investigations confirmed this as a case of renal infarction. Renal infarction is underdiagnosed because of the similarity of its presentation to other renal pathology. Renal infarction should be considered in the differential diagnosis of loin pain, particularly in a patient with atrial fibrillation.

Drug evaluation of clevidipine for acute hypertension

Background: Clevidipine is an investigational agent undergoing late-stage clinical development to evaluate its potential as a novel short-acting intravenous agent for treating acute hypertension, either in hypertensive emergencies encountered in the emergency department and intensive care units, or in the perioperative period. Method: Clevidipine has been evaluated in four Phase I studies, nine Phase II studies and six Phase III clinical studies. The patient populations studied include healthy volunteers, patients with essential hypertension, patients undergoing cardiac surgery, and patients presenting to the emergency department with hypertensive emergencies. Studies providing comparative data of clevidipine versus nitroglycerin, nicardipine or sodium nitroprusside are also available. Objective: This article reviews the results of clinical studies evaluating the pharmacological properties, clinical effects and safety profiles of clevidipine in various patient populations. Results/conclusion: Clevidipine is an effective agent for reducing acute elevation in blood pressure in various settings, including hypertensive emergencies and perioperative hypertension with a good safety profile.

Obstructive Sleep Apnea and Hypertension

There has long been a recognized link between obstructive sleep apnea (OSA) and the cardiovascular system, no aspect of which has been more studied than blood pressure. Research in OSA has not only demonstrated dysregulation of homeostatic cardiovascular mechanisms but also has furthered our understanding of blood pressure regulatory control. Acute nocturnal blood pressure elevations associated with disordered breathing events have been reproduced from a number of observational studies, the accrual of which has also made an increasing argument for the importance of OSA in the pathogenesis of diurnal hypertension, as suggested by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), which implicated OSA as a secondary cause of hypertension. Accumulating data from randomized controlled treatment trials in OSA, particularly with continuous positive airway pressure, though sometimes inconsistent, suggest a potential role in blood pressure reduction. Further research is needed to better clarify indications for OSA treatment as well as its role as an adjunct to other antihypertensive treatments.