open access
Resistant hypertension and obstructive sleep apnea
open access
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.
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.
Keywords
arterial hypertension, resistant hypertension, obstructive sleep apnea (OSA)
About this articleTitle
Resistant hypertension and obstructive sleep apnea
Journal
Issue
Article type
Review paper
Pages
95-100
Published online
2015-06-24
Page views
962
Article views/downloads
3065
DOI
10.5603/AH.2015.0013
Bibliographic record
Arterial Hypertension 2015;19(2):95-100.
Keywords
arterial hypertension
resistant hypertension
obstructive sleep apnea (OSA)
Authors
Beata Krasińska
Szczepan Cofta
Angelika Miazga
Ludwina Szczepaniak-Chicheł
Tomasz Trafas
Zbigniew Krasiński
Andrzej Tykarski