Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure

Kario, Kazuomi

doi:10.1038/hr.2009.56

Cited by 154 publications

(109 citation statements)

References 28 publications

(23 reference statements)

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“…58 Associations between obstructive sleep apnea (OSA) and high BP have been confirmed, and nondipping was found in 48-84% of the patients with OSA. [59][60][61] The mechanisms contributing to nondipping or nocturnal hypertension in OSA are multifactorial, including hypoxia-and hypercapnea-induced sympathetic nerve activation, renin-angiotensin-aldosterone activation, endothelial dysfunction and increased vascular stiffness. [59][60][61][62] The effectiveness of OSA treatment with continuous positive airway pressure (CPAP) was modest and the results are conflicting.…”

Section: Treatment Of Nocturnal Bp Increasesmentioning

confidence: 99%

“…[59][60][61] The mechanisms contributing to nondipping or nocturnal hypertension in OSA are multifactorial, including hypoxia-and hypercapnea-induced sympathetic nerve activation, renin-angiotensin-aldosterone activation, endothelial dysfunction and increased vascular stiffness. [59][60][61][62] The effectiveness of OSA treatment with continuous positive airway pressure (CPAP) was modest and the results are conflicting. 62 Haentjens et al 63 examined the effects of CPAP on 24-hour BP with a meta-analysis of 572 patients from 12 randomized controlled trials.…”

Section: Treatment Of Nocturnal Bp Increasesmentioning

confidence: 99%

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Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.

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Section: Treatment Of Nocturnal Bp Increasesmentioning

confidence: 99%

Section: Treatment Of Nocturnal Bp Increasesmentioning

confidence: 99%

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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“…45 It has been shown that obstructive sleep apnea predominantly increases nighttime BP and its variability because of BP surges due to hypoxia/hypercapnea during episodes of apnea. 45,46 Therefore, obesity and sleep apnea may cause nighttime hypertension (Table 1).…”

Section: Obesity and Sleep Apneamentioning

confidence: 99%

Diurnal blood pressure variation and related behavioral factors

Kawano

2010

Hypertens Res

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Blood pressure (BP) varies according to many internal and external factors, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies throughout the day and night. These changes in BP are closely related to mental and physical activities, and the sympathetic nervous system mainly contributes to the diurnal variation in BP. Other behavioral factors, such as food consumption and obesity, dietary intake of sodium, drinking and smoking habits, consumption of coffee and tea, and bathing, also affect the diurnal variation in BP. Alterations in diurnal BP variation due to behavioral factors are frequently seen in patients with hypertension and can be classified as morning hypertension, daytime hypertension and nighttime hypertension. Appropriate lifestyle modifications may normalize or improve both the level and rhythm of BP in these patients. Hypertension Research (2011) 34, 281-285; doi:10.1038/hr.2010.241; published online 2 December 2010Keywords: ambulatory blood pressure monitoring; diurnal blood pressure variation; lifestyle; mental stress; physical activity INTRODUCTION Blood pressure (BP) varies according to many internal and external factors. There are several distinctive rhythmic variations in BP including diurnal (or circadian) variation, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies with changes in mental and physical activities during daytime and nighttime. [1][2][3][4] In addition to the awake and sleep cycle, many behavioral factors, such as mental stress, exercise, food consumption, changes in body weight, dietary intake of sodium and other electrolytes, drinking and smoking habits, consumption of coffee and tea, and bathing, influence both the level and variation in BP. [5][6][7][8] Understanding the influences of those behavioral factors on diurnal BP variation is important for the management of hypertension because alterations in diurnal BP variation due to behavioral factors are observed in many hypertensive subjects. 9,10 It has been shown that ambulatory BP monitoring is useful for assessing the influence of behavioral factors as well as the effects of lifestyle modifications on the level and pattern of BP throughout the day. 11,12 In this review article, I would like to summarize the effects of behavioral factors on diurnal BP variation with respect to the pathophysiology of hypertension and the effects of lifestyle modifications on 24-h BP.

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“…25 Moreover, 'midnight BP surge' observed during episodes of apnea, is also suppressed by CPAP therapy. 26,27 In patients with nocturnal hypertension, severe OSAS (AHI430) and high body mass index, 21,28 CPAP has been reported to markedly reduce BP. 22 The presence or absence of daytime sleepiness also influences the BP-lowering effect of CPAP.…”

Section: Cpap Therapymentioning

confidence: 99%

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

Kario

2009

Hypertens Res

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Hypertensive patients with obstructive sleep apnea syndrome (OSAS) constitute a high-risk group for metabolic syndrome. OSAS directly induces negative intrathoracic pressure and decreases pulmonary stretch receptor stimulation, chemoreceptor stimulation, hypoxemia, hypercapnia and microarousal. These changes potentiate various risk factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system and inflammation. Early detection and treatment of OSAS in asymptomatic hypertensive patients is essentially important to prevent hypertensive target organ damage and subsequent cardiovascular events. Continuous positive airway pressure (CPAP) therapy, a first-line treatment in hypertensive patients with moderate to severe OSAS, reduces ambulatory BP level, particularly during the sleep period, and midnight BP surge. However, individual differences in the BP-lowering effect of CPAP have been observed. OSAS hypertensive patients who do not tolerate CPAP remain at a high risk for cardiovascular disease because of negative intrathoracic pressure and need more aggressive antihypertensive treatment to achieve 24-h BP control with nocturnal BP o120/70 mm Hg.

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Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure

Cited by 154 publications

References 28 publications

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

Diurnal blood pressure variation and related behavioral factors

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

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