Abstract
Obstructive sleep apnea (OSA) and hypertension (HT) are widespread, sometimes associated disorders that enhance each other and result in high morbidity and mortality rates. Resistant hypertension (RHT) is a specific condition defined as high blood pressure that remains uncontrolled despite treatment with at least three antihypertensive drugs (including a diuretic) at optimal doses. Given that RHT is very common in OSA patients, OSA is now considered one of the leading causes of RHT and RHT screening is mandatory in such cases. Some of the mechanisms seen in HT pathogenesis are also present (with specific particularities) in the OSA-HT association. Thus, factors like increased sympathetic tone, renin-angiotensinaldosterone system, endothelial dysfunction, vasoactive substances, inflammation, oxidative stress, nocturnal rostral fluid shift and excessive daytime sleepiness add their burden to the pathological chain, leading to both resistance and nondipping profile of HT. Consequently, we can assume that continuous positive airway pressure (CPAP) therapy in OSA patients has an impact on HT and HT resistance. This review describes the effect of CPAP on the above-mentioned links of the pathological chain, while providing information on new methods of assessing the cardiovascular risk in these patients, a history of the most important studies on the OSA-RHT association and the outcomes of a recent meta-analysis showing a positive effect of CPAP on 24-hour BP monitoring in patients with OSA and RHT compared to standard antihypertensive treatment.
Keywords: Arterial hypertension, blood pressure variability, continuous positive airway pressure, meta-analysis, obstructive sleep apnea syndrome, resistant hypertension.
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