Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension

Cabrini, Mayara Longui; Macedo, Thiago Andrade; Castro, Emerson Fernandes de Sousa e; Barros, Silvana de; Azam, I.F.B.; Pio-Abreu, Andrea; Silva, Giovanio V.; Lorenzi-Filho, Geraldo; Bortolotto, Luiz Aparecido; Drager, Luciano F.

doi:10.1038/s41440-023-01320-z

Cited by 6 publications

(4 citation statements)

References 56 publications

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“…19 Recurrent hypoxia occurring in patients with OSA triggers endothelial dysfunction and activates the RAAS and sympathetic systems, leading to systemic inflammation and oxidative stress that contribute to RH and HMOD occurrence. 37,38 Several classes of drugs can increase BP through various mechanisms, such as increased systemic and renal vasoconstriction, sodium retention and angiotensin biosynthesis. These pharmacological agents include nonsteroidal anti-inflammatory agents, oral contraceptives, immunosuppressive treatments such as cyclosporine and tacrolimus, antineoplastic drugs targeting the vascular endothelial growth factor pathway, steroids and antidepressants.…”

Section: Pathophysiological Mechanismsmentioning

confidence: 99%

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The Global Burden of Resistant Hypertension and Potential Treatment Options

Buso,

Agabiti-Rosei,

Lemoli

et al. 2024

Eur Cardiol

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Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains ≥140 mmHg or ≥90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.

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Section: Pathophysiological Mechanismsmentioning

confidence: 99%

“…[ 19 ] Recurrent hypoxia occurring in patients with OSA triggers endothelial dysfunction and activates the RAAS and sympathetic systems, leading to systemic inflammation and oxidative stress that contribute to RH and HMOD occurrence. [ 37 , 38 ]…”

Section: Pathophysiological Mechanismsmentioning

confidence: 99%

The Global Burden of Resistant Hypertension and Potential Treatment Options

Buso,

Agabiti-Rosei,

Lemoli

et al. 2024

Eur Cardiol

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“…Both OSA and hypertension are well-known CVDs risk factors, with a strong bidirectional association between OSA and hypertension ( 7 ). Furthermore, OSA has been independently associated with target-organ damage (e.g., arterial stiffness, heart remodeling and left ventricular hypertrophy) in patients with hypertension ( 8 , 9 ), suggesting a potential role of OSA in hypertension prognosis. Hence, the co-occurrence of OSA and hypertension is thought to significantly increase the risk of CVDs ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea remains a risk factor for major adverse cardiovascular and cerebrovascular events even in hypertensive patients under treatment: the Urumqi Research on Sleep Apnea and Hypertension (UROSAH) data

Yao,

Li,

Heizhati

et al. 2023

Cardiovasc Diagn Ther

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Background The impact of the co-occurrence of hypertension and obstructive sleep apnea (OSA) on the risk of long-term cardiovascular disease (CVD) outcomes has not been extensively studied in the Asian population, and the residual effect of OSA on CVD in patients under antihypertensive treatment is not clear. The study aimed to explore the impact of OSA on the risk of CVD outcomes in a large-scale Asian cohort under antihypertensive treatment using retrospective design. Methods Hypertensive patients who underwent polysomnography (PSG) test from January 2011 to December 2013 were recruited from the Urumqi Research on Sleep Apnea and Hypertension (UROSAH) cohort, which was conducted in Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region. OSA was defined as apnea hypopnea index (AHI) ≥5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of nonfatal myocardial infarction, nonfatal stroke, revascularization, rehospitalization due to unstable angina or heart failure and all-cause death. Cox regression analysis was performed to explore the effect of OSA and hypertension coexistence on MACCE. Results A total of 3,329 hypertension patients were enrolled, of whom 2,585 patients (about 77.7%) suffered from OSA. During a median follow-up period of 7.0 years, 415 patients developed extended MACCE. The incidence of extended MACCE was significantly greater in patients with OSA than those without OSA [hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.27–1.99; P<0.001]. Overall, patients with OSA had an increased risk of cardiac events of 57% compared to those without OSA (HR: 1.57; 95% CI: 1.04–2.39, P=0.034) and the association did not change in further sensitivity analysis. Particularly in uncontrolled hypertension, OSA was found to have a 93% increased risk of cardiac events, compared with patients without OSA (P=0.036). Conclusions Untreated OSA seemed to be a factor affecting the prognosis of cardiac events in hypertensive patients, although the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control, which highlights the need to treat OSA.

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Comment on original article, Cheng et al's "Obstructive Sleep Apnea in Relation to .Obstructive sleep apnea (OSA) is associated with hypertension and cardiovascular disease [2,3]. In 786 hospitalized patients with hypertension, Cheng et al performed 10-min awake beat-to-beat blood pressure (BP) monitoring (n = 705), 24-h ambulatory BP monitoring (ABPM) (n = 779), 7-day home BP monitoring (n = 445) and the full overnight polysomnography.

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confidence: 99%

Hypertension and blood pressure variability in patients with obstructive sleep apnea

Mizuno

2024

Hypertens Res

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Comment on original article, Cheng et al.'s "Obstructive Sleep Apnea in Relation to .Obstructive sleep apnea (OSA) is associated with hypertension and cardiovascular disease [2,3]. In 786 hospitalized patients with hypertension, Cheng et al. performed 10-min awake beat-to-beat blood pressure (BP) monitoring (n = 705), 24-h ambulatory BP monitoring (ABPM) (n = 779), 7-day home BP monitoring (n = 445) and the full overnight polysomnography. Variability independent of the mean (VIM), average real variability (ARV), and maximum-minimum difference (MMD) were used as indices of BP variability. In univariate analysis, VIM and MMD in awake beat-to-beat systolic BP, and sleep systolic and diastolic ARV and MMD increased from patients without obstructive sleep apnea syndrome (OSAS), to patients with mild, moderate and severe OSAS. After adjustment for confounders, this increasing trend for VIM and MMD in awake beat-to-beat systolic BP remained statistically significant. This study reported clinically significant results. However, it has several limitations.The first limitation is that the authors measured only awake beat-to-beat BP during daytime and not sleep beatto-beat BP during nighttime. If sleep beat-to-beat BP had been available, the BP variability between awake and sleep beat-to-beat BP could be compared, which may become additional important findings. For example, it is clinically important whether 10-min awake beat-to-beat BP variability can predict severity of sleep beat-to-beat BP variability.

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Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension

Cited by 6 publications

References 56 publications

The Global Burden of Resistant Hypertension and Potential Treatment Options

The Global Burden of Resistant Hypertension and Potential Treatment Options

Obstructive sleep apnea remains a risk factor for major adverse cardiovascular and cerebrovascular events even in hypertensive patients under treatment: the Urumqi Research on Sleep Apnea and Hypertension (UROSAH) data

Hypertension and blood pressure variability in patients with obstructive sleep apnea

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