Resistant hypertension and obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) remains one of the most common causes of resistant arterial hypertension (AH). Association between resistant hypertension and OSA was observed in numerous trials. In patients suffering from OSA resistant AH occurs in 37–56% of cases, while prevalence of OSA in group of patients suffering from resistant AH is as much as 70–85%. Presumably pathogenesis of resistant hypertension is determined by coexistence of several mechanisms. The key role in that process plays hypoxia which leads to sympathetic nervous system stimulation, activation of renin-angiotensin system, increase of oxydative stress and endothelin production. Activation of renin-angiotensin system with increase in angiotensin II and aldosterone concentrations leads to rise in peripheral vascular resistance, and in consequence increased afterload. Coexistence of OSA diminishes effectiveness of hypotensive treatment. In order to achieve blood pressure control it is necessary to use simultaneously several antihypertensive agents with different mechanism of action, including a diuretic.