In patients with resistant hypertension and OSA, CPAP treatment for 3 months achieves reductions in 24-h BP. This effect is seen in patients with ABPM-confirmed resistant hypertension who use CPAP more than 5.8 h.

Obstructive sleep apnea syndrome (OSAS) is a process that is associated with the development of arterial hypertension, the main risk factor for aortic dissection and during obstructive episodes of the upper airways with marked increases in transmural pressure of the aorta wall. The aim of this work was to study the association between aortic dissection and OSAS. Nineteen consecutive patients with thoracic aorta dissection and 19 hypertensive patients of similar age, sex, and body mass index were studied by clinical questionnaire and polysomnography. Snoring and nonrefreshing sleep were common in both groups. Thirteen patients (68%) from each group showed an apnea-hypopnea index of more than 5 per hour. However, patients with aortic dissection presented a higher apnea-hypopnea index (28 [30.3] versus 11.1 [10.4], p=0.032). Seven patients with dissection presented an apnea-hypopnea index of more than 30 versus 1 patient in the control group (p=0.042). Patients with thoracic aorta dissection presented a high prevalence of previously undiagnosed and frequently severe OSAS. Further studies, including this diagnosis as a prognostic variable in the follow-up of patients with aortic dissection, are required. Our results suggest that in patients with aortic dissection and symptoms consistent with OSAS, a sleep study should be considered in their clinical management.

C urrent guidelines recommend the assessment of vascular risk factors, target organ damage, and blood pressure (BP) levels to guide the treatment on primary hypertension.1 Besides BP levels, other BP-related features, such as the nocturnal dipping 2 or more recently, visit-to-visit or long-term BP variability (BPV), have been independently associated with clinical cardiovascular outcomes in a recent systematic review and meta-analysis. 3 Also, the prognostic value of BPV measured with ambulatory BP monitoring (ABPM) for 24 hours (also value-to-value or short-term BPV) has been evaluated. Data on short-term BPV from 11 populations 4 suggest a positive association between measures of short-term BPV and cardiovascular death or any (fatal and nonfatal) event. Although the contribution of short-term BPV to the prediction of cardiovascular events was shown to be small (<1%), this is still a matter of debate because results from individual studies support significant contributions. 5,6 It has been also suggested that the prognostic significance of BPV on stroke risk is weaker for short-term than for longterm BPV in treated hypertension. 7 However, these data need further investigation taking into account not only between subject BPV but also within subject BPV.Moreover, several indices of short-term BPV have been related to the presence of subclinical damage in one or multiple organs, including the heart, kidney, and vessels, independently of BP levels. [8][9][10] About the brain, hypertension is a major risk factor for cerebral small vessel disease (CSVD), which is an Abstract-Blood pressure (BP) variability is associated with stroke risk, but less is known about subclinical cerebral small vessel disease (CSVD). We aimed to determine whether CSVD relates to short-term BP variability independently of BP levels and also, whether they improve CSVD discrimination beyond clinical variables and office BP levels. This was a cohort study on asymptomatic hypertensives who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. Office and average 24-hour, daytime and nighttime BP levels, and several metrics of BP variability (SD, weighted SD, coefficient of variation, and average real variability [ARV]) were calculated. Definition of CSVD was based on the presence of lacunar infarcts and white matter hyperintensity grades. Multivariate analysis and integrated discrimination improvement were performed to assess whether BP variability and levels were independently associated with CSVD and improved its discrimination. Four hundred eighty-seven individuals participated (median age, 64; 47% women). CSVD was identified in 18.9%, related to age, male sex, diabetes mellitus, use of treatment, ambulatory BP monitoring-defined BP levels, and ARV of systolic BP at any period. The highest prevalence (33.7%) was found in subjects with both 24-hour BP levels and ARV elevated. BP levels at any period and ARV (24 hours and nocturnal) emerged as independent predictors of CSVD, and discrimination was incrementally improv...