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

Area of Science:

• Cardiology
• Sleep Medicine
• Hypertension Research

Background:

• Hypertension is a major cardiovascular risk factor, with resistant hypertension (RH) and refractory hypertension (RfH) posing significant challenges.
• Patients with RH and RfH exhibit difficult-to-control blood pressure, increasing their cardiovascular risk.
• Pathophysiological mechanisms like renin-angiotensin-aldosterone axis alterations and sympathetic hyper-activation are implicated in RH and RfH.

Purpose of the Study:

• To investigate the high prevalence of obstructive sleep apnea (OSA) in patients with resistant hypertension (RH) and refractory hypertension (RfH).
• To evaluate the efficacy of continuous positive airway pressure (CPAP) treatment in reducing blood pressure in hypertensive patients with OSA.
• To emphasize the importance of screening for OSA in the multidimensional treatment of RH and RfH.

Main Methods:

• Observational studies and clinical data analysis were used to determine OSA prevalence in RH and RfH cohorts.
• Clinical trials assessed the impact of CPAP therapy on blood pressure reduction in hypertensive patients with diagnosed OSA.
• Literature review synthesized current understanding of pathophysiological links between OSA, RH, and RfH.

Main Results:

• Obstructive sleep apnea (OSA) is highly prevalent in patients diagnosed with resistant hypertension (RH) and refractory hypertension (RfH).
• Continuous positive airway pressure (CPAP) treatment demonstrated a clinically significant reduction in blood pressure levels for both RH and RfH patients with OSA.
• The findings highlight OSA as a critical, treatable comorbidity in difficult-to-control hypertension.

Conclusions:

• Screening for obstructive sleep apnea (OSA) should be integrated into the comprehensive management of patients with resistant hypertension (RH) and refractory hypertension (RfH).
• Continuous positive airway pressure (CPAP) offers a valuable therapeutic option for lowering blood pressure in this patient population.
• Further research is needed to optimize combination therapies (e.g., CPAP, pharmacotherapy, renal denervation) and understand variable patient responses to CPAP.