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Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension

Hypertension Research volume 46, pages 2033–2043 (2023)Cite this article

Abstract

The potential role of obstructive sleep apnea (OSA) in hypertension-mediated organ damage (HMOD) may be influenced by the presence of resistant hypertension (RH). Herein, we enrolled patients with hypertension from a tertiary center for clinical evaluation and performed a sleep study to identify OSA (apnea-hypopnea index ≥15 events/h) and a blinded analysis of four standard HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [≥10 m/s], presence of retinopathy, and nephropathy). RH was diagnosed based on uncontrolled blood pressure (BP) (≥140/90 mmHg) despite concurrent use of at least three antihypertensive drug classes or controlled BP with concurrent use of ≥4 antihypertensive drug classes at optimal doses. To avoid the white-coat effect, ambulatory BP monitoring was performed to confirm RH diagnosis. One-hundred patients were included in the analysis (mean age: 54 ± 8 years, 65% females, body mass index: 30.4 ± 4.5 kg/m²). OSA was detected in 52% of patients. Among patients with non-RH (n = 53), the presence of OSA (52.8%) was not associated with an increased frequency of HMOD. Conversely, among patients with RH, OSA (51.1%) was associated with a higher incidence of LVH (RH-OSA,61%; RH + OSA,87%; p = 0.049). Logistic regression analysis using the total sample revealed that RH (OR:7.89; 95% CI:2.18–28.52; p = 0.002), systolic BP (OR:1.04; 95% CI:1.00–1.07; p = 0.042) and OSA (OR:4.31; 95% CI:1.14–16.34; p = 0.032) were independently associated with LVH. No significant association was observed between OSA and arterial stiffness, retinopathy, or nephropathy. In conclusion, OSA is independently associated with LVH in RH, suggesting a potential role of OSA in RH prognosis.

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Acknowledgements

We thank all patients included in this study.

Funding

This work was supported by a research grant from FAPESP (2019/23496-8).

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Authors and Affiliations

  1. Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

    Mayara L. Cabrini, Silvana de Barros, Indira Azam, Andrea Pio-Abreu, Giovanio V. Silva & Luciano F. Drager

  2. Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

    Thiago A. Macedo, Emerson Castro, Luiz A. Bortolotto & Luciano F. Drager

  3. Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

    Geraldo Lorenzi-Filho

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  1. Mayara L. Cabrini
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  2. Thiago A. Macedo
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Correspondence to Luciano F. Drager.

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Cabrini, M.L., Macedo, T.A., Castro, E. et al. Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension. Hypertens Res 46, 2033–2043 (2023). https://doi.org/10.1038/s41440-023-01320-z

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