Obstructive Sleep Apnea

Author:

Pedrosa Rodrigo P.1,Drager Luciano F.1,Gonzaga Carolina C.1,Sousa Marcio G.1,de Paula Lílian K.G.1,Amaro Aline C.S.1,Amodeo Celso1,Bortolotto Luiz A.1,Krieger Eduardo M.1,Bradley T. Douglas1,Lorenzi-Filho Geraldo1

Affiliation:

1. From the Sleep Laboratory, Pulmonary Division (R.P.P., L.F.D., L.K.G.d.P., A.C.S.A., G.L.-F.), and Hypertension Unit (L.F.D., L.A.B., E.M.K.), Heart Institute, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (R.P.P.), Universidade de Pernambuco, Pernambuco, Brazil; Department of Hypertension and Nephrology (C.C.G., M.G.S., C.A.), Instituto Dante Pazzanese de Cardiologia, São Paulo, São...

Abstract

Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9–14.2]; P <0.01), neck circumference ≥41 cm for women and ≥43 cm for men (odds ratio: 4.7 [95% CI: 1.3–16.9]; P =0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3–11]; P =0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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