Effect of continuous positive airway pressure in patients with true refractory hypertension and sleep apnea

Navarro-Soriano, Cristina; Martínez-García, Miguel-Ángel; Torres, Gerard; Barbé, Ferrán; Caballero-Eraso, Candela; Lloberes, Patrícia; Cambriles, Trinidad Díaz; Somoza, María Salgado; Masa, Juan F.; González, Mónica; Baena, Eva Mañas; Peña, Mónica de la; García‐Río, Francisco; Montserrat, Josep M.; Muriel, Alfonso; Oscullo, Grace; Olmos, Laura Feced; García-Ortega, Alberto; Calhoun, David A.; Campos‐Rodríguez, Francisco

doi:10.1097/hjh.0000000000002053

Cited by 39 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1. The prevalence of OSA in RfH patients (AHI !15 events/h) was greater than 90%, meaning that these patients were almost twice as likely to suffer from OSA as those with resistant hypertension [15]. In short, the HIPARCO-1 and HIPARCO-2 studies constitute the largest RCT and long-term longitudinal studies to date on the impact of CPAP treatment in patients with resistant hypertension and RfH.…”

Section: Long-term Adherence To Cpap Treatment In Patientsmentioning

confidence: 98%

The effect of continuous positive airway pressure on patients with resistant and refractory hypertension: lessons from the HIPARCO programme

Martínez‐García

2021

Journal of Hypertension

View full text Add to dashboard Cite

Section: Long-term Adherence To Cpap Treatment In Patientsmentioning

confidence: 98%

The effect of continuous positive airway pressure on patients with resistant and refractory hypertension: lessons from the HIPARCO programme

Martínez‐García

2021

Journal of Hypertension

View full text Add to dashboard Cite

“…Use of CPAP, the treatment of choice for patients with OSA, for 3 months has been shown to result in reductions in DBP, especially at night, in patients with both RHTN and RfHTN. The analysis also showed a significant decrease (9 mmHg) in SBP in the RfHTN group, but not in the RHTN group [ 40 ]. Neither of these studies specified the need for use of long-acting thiazide diuretics or MRAs to define RfHTN.…”

Section: Managementmentioning

confidence: 99%

An Update on Refractory Hypertension

et al. 2022

Self Cite

View full text Add to dashboard Cite

Purpose of Review To update on definition, diagnosis, prevalence, patient characteristics, pathophysiology, and treatment of refractory hypertension (RfHTN). Recent Findings Refractory hypertension (RfHTN) is defined as blood pressure (BP) that is uncontrolled despite using ≥ 5 antihypertensive medications of different classes, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist (MRA) at maximal or maximally tolerated doses. This new phenotype is different from resistant hypertension (RHTN), defined as BP that is uncontrolled despite using ≥ 3 medications, commonly a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB]), and a diuretic. The RHTN phenotype includes controlled RHTN, BP that is controlled on 4 or more medications. RfHTN is largely attributable to increased sympathetic activity, unlike RHTN, which is mainly due to increased intravascular fluid volume frequently caused by hyperaldosteronism and chronic excessive sodium ingestion. Compared to those with controlled RHTN, patients with RfHTN have a higher prevalence of target organ damage and do not have elevated aldosterone levels. Ongoing clinical trials are assessing the safety and efficacy of using devices to aid with BP control in patients with RfHTN. Summary RfHTN is a separate entity from RHTN and is generally attributable to increased sympathetic activity.

show abstract

“…The authors concluded that randomised clinical trials were needed to confirm their results. Since then, more than 20 studies have been published on different aspects of the effect of CPAP treatment in patients with RH or RfH: nine randomised controlled trials [RCT] [17,71,77,78,79,80,81,82,83], two of them on the effect on aldosterone concentration [79,82] and one on the effect on leptin concentration [84] (Table 2); four observational trials [84,85,86,87]; five meta-analyses and systematic reviews [72,88,89,90,91]; and, finally, five studies on additional topics, such as methodology [92], personalised medicine [75], adherence to CPAP treatment [93] and the combined effect of CPAP and renal denervation [63]. The first RCT on the effect of CPAP on BP levels in RH was performed by Lozano et al in 2010 [77] in 64 patients with ABPM-confirmed RH.…”

Section: Multidimensional Treatmentmentioning

confidence: 99%

“…BP readings dropped more markedly in those patients with RfH than in those with RH, in both 24 h SBP (9 vs. 1.6 mmHg, p = 0.021) and 24 h DBP (7.3 vs. 2.3 mmHg, p = 0.074), especially at night (11.3 vs. 3.8, p = 0.121 and 8.8 vs. 2.2, p = 0.054). The adjusted difference between groups was statistically significant in 24 h SBP levels (7.4 mm Hg, p = 0.021) [80]. Moreover, one of the factors associated with the progression over time from an RH to an RfH phenotype in those patients with OSA was non-adherence to CPAP treatment [94].…”

Section: Multidimensional Treatmentmentioning

confidence: 99%

Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges

Oscullo

Torres

Campos‐Rodríguez

et al. 2019

JCM

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Effect of continuous positive airway pressure in patients with true refractory hypertension and sleep apnea

Cited by 39 publications

References 25 publications

The effect of continuous positive airway pressure on patients with resistant and refractory hypertension: lessons from the HIPARCO programme

The effect of continuous positive airway pressure on patients with resistant and refractory hypertension: lessons from the HIPARCO programme

An Update on Refractory Hypertension

Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges

Contact Info

Product

Resources

About