Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension.
Mayara L CabriniThiago A MacedoEmerson CastroSilvana de BarrosIndira AzamAndrea Pio-AbreuGiovanio V SilvaGeraldo Lorenzi-FilhoLuiz A BortolottoLuciano Ferreira DragerPublished in: Hypertension research : official journal of the Japanese Society of Hypertension (2023)
The potential role of obstructive sleep apnea (OSA) in hypertension-mediated organ damage (HMOD) may be influenced by the presence of resistant hypertension (RH). Herein, we enrolled patients with hypertension from a tertiary center for clinical evaluation and performed a sleep study to identify OSA (apnea-hypopnea index ≥15 events/h) and a blinded analysis of four standard HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [≥10 m/s], presence of retinopathy, and nephropathy). RH was diagnosed based on uncontrolled blood pressure (BP) (≥140/90 mmHg) despite concurrent use of at least three antihypertensive drug classes or controlled BP with concurrent use of ≥4 antihypertensive drug classes at optimal doses. To avoid the white-coat effect, ambulatory BP monitoring was performed to confirm RH diagnosis. One-hundred patients were included in the analysis (mean age: 54 ± 8 years, 65% females, body mass index: 30.4 ± 4.5 kg/m²). OSA was detected in 52% of patients. Among patients with non-RH (n = 53), the presence of OSA (52.8%) was not associated with an increased frequency of HMOD. Conversely, among patients with RH, OSA (51.1%) was associated with a higher incidence of LVH (RH-OSA,61%; RH + OSA,87%; p = 0.049). Logistic regression analysis using the total sample revealed that RH (OR:7.89; 95% CI:2.18-28.52; p = 0.002), systolic BP (OR:1.04; 95% CI:1.00-1.07; p = 0.042) and OSA (OR:4.31; 95% CI:1.14-16.34; p = 0.032) were independently associated with LVH. No significant association was observed between OSA and arterial stiffness, retinopathy, or nephropathy. In conclusion, OSA is independently associated with LVH in RH, suggesting a potential role of OSA in RH prognosis.
Keyphrases
- obstructive sleep apnea
- blood pressure
- positive airway pressure
- hypertensive patients
- sleep apnea
- heart rate
- body mass index
- left ventricular
- ejection fraction
- end stage renal disease
- newly diagnosed
- prognostic factors
- heart failure
- clinical trial
- physical activity
- chronic kidney disease
- oxidative stress
- adipose tissue
- adverse drug
- blood glucose
- risk factors
- clinical evaluation
- randomized controlled trial
- type diabetes
- weight loss
- atrial fibrillation
- left atrial
- study protocol
- climate change
- emergency department
- metabolic syndrome
- data analysis
- aortic stenosis
- mitral valve
- single cell