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The Potential Role of Obstructive Sleep Apnoea in Refractory Hypertension

  • Grace Oscullo
  • E. Sapiña-Beltrán
  • Gerard Torres
  • Enrique Zaldivar
  • Ferran Barbé
  • Miguel Angel Martinez-GarciaEmail author
Resistant Hypertension (Luciano Drager, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Resistant Hypertension

Abstract

Purpose of Review

This review seeks to present an overview of the recently found association between refractory hypertension (RfH) and obstructive sleep apnoea (OSA).

Recent Findings

RfH was recently defined as an extreme phenotype of resistant hypertension characterized by the lack of blood pressure control despite using ≥ 5 antihypertensive drugs at optimal doses. Current data support that the pathophysiological pathway of both types of hypertension is different. The main mechanism involved in resistant hypertension is fluid retention whereas in the case of RfH is the sympathetic over-activity. OSA is now recognized as a cause of hypertension (especially in the case of difficult-to-treat hypertension). It seems that the biological mechanism linking OSA and arterial hypertension is the sympathetic over-activity related to the respiratory events (apnoeas and hypopnoeas) during the night. So, it is not surprising that, although the literature is scarce, some studies have found a very high prevalence of OSA and an excess of sympathetic activity in patients with RfH. Finally, a very recent study demonstrated that continuous positive airway pressure (CPAP) treatment, which controls sympathetic activation in OSA patients, achieves very significant reductions in blood pressure levels in RfH patients, even greater than in those with resistant (non-refractory) hypertension.

Summary

The prevalence of OSA in patients with RfH is very high. CPAP treatment achieves a clinically significant reduction in blood pressure levels in those patients with RfH (especially in night readings). Patients with RfH must be sent to a sleep unit for a study.

Keywords

Sleep apnoea Resistant hypertension Refractory hypertension Continuous positive airway pressure 

Notes

Author Contribution

All authors have access to the data and a role in writing the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Grace Oscullo
    • 1
  • E. Sapiña-Beltrán
    • 2
    • 3
  • Gerard Torres
    • 2
    • 3
  • Enrique Zaldivar
    • 1
  • Ferran Barbé
    • 2
    • 3
  • Miguel Angel Martinez-Garcia
    • 1
    Email author
  1. 1.Pneumology DepartmentHospital Universitario y Politécnico La FeValenciaSpain
  2. 2.Group of Translational Research in Respiratory Medicine, IRBLleidaHospital Universitari Arnau de Vilanova and Santa MariaLleidaSpain
  3. 3. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain

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