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Sleep and Resistant Hypertension

  • Sleep and Hypertension (S Justin Thomas, Section Editor)
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Abstract

Purpose of Review

The goal of the present review is to describe the current findings on the association of sleep with resistant hypertension (hypertension that remains uncontrolled despite the use of three or more antihypertensive medications from different classes, including a diuretic).

Recent Findings

Sleep disturbances, particularly obstructive sleep apnea (OSA), are highly prevalent among adults who have resistant hypertension. Randomized controlled trials indicate that treating OSA has modest effects on blood pressure lowering among those with the highest initial blood pressure. There is a paucity of research on the association of habitual sleep and other sleep disturbances with resistant hypertension. Of note, the most recent observational studies describing the association of OSA with resistant hypertension are comprised primarily of non-white race/ethnic groups who are far more likely to have resistant hypertension.

Summary

OSA is associated with resistant hypertension, but there is limited data on associations between sleep characteristics and resistant hypertension. Future studies should investigate whether treating OSA can reduce disparities in resistant hypertension and whether other aspects of sleep also contribute to resistant hypertension.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Carey RM, Sakhuja S, Calhoun DA, et al. Prevalence of apparent treatment-resistant hypertension in the United States. Hypertension. 2019;73(2):424–31. This paper describes the prevalence of treatment resistant hypertension in the US population.

    Article  CAS  PubMed  Google Scholar 

  2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):e127–248.

    Article  PubMed  Google Scholar 

  3. • Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72(5):e53–90. This paper provides current treatment guidelines for managing resistant hypertension including recommendations for screening for obstructive sleep apnea.

    Article  CAS  PubMed  Google Scholar 

  4. Noubiap JJ, Nansseu JR, Nyaga UF, Sime PS, Francis I, Bigna JJ. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart. 2019;105(2):98–105.

    Article  PubMed  Google Scholar 

  5. Acelajado MC, Pisoni R, Dudenbostel T, Dell’Italia LJ, Cartmill F, Zhang B, et al. Refractory hypertension: definition, prevalence, and patient characteristics. J Clin Hypertens (Greenwich). 2012;14(1):7–12.

    Article  Google Scholar 

  6. National Center for Health Statistics. Summary health statistics tables for US adults: National Health Interview Survey 2014. 2016. (http://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2014_SHS_Table_A-1.pdf). (Accessed September 28 2016).

  7. Tarver-Carr ME, Powe NR, Eberhardt MS, et al. Excess risk of chronic kidney disease among African-American versus white subjects in the United States: a population-based study of potential explanatory factors. J Am Soc Nephrol. 2002;13(9):2363–70.

    Article  PubMed  Google Scholar 

  8. Muntner P, Newsome B, Kramer H, Peralta CA, Kim Y, Jacobs DR, et al. Racial differences in the incidence of chronic kidney disease. Clin J Am Soc Nephrol. 2012;7(1):101–7.

    Article  CAS  PubMed  Google Scholar 

  9. Fryar CD, Ostchega Y, Hales CM, et al. Hypertension prevalence and control among adults: United States, 2015-2016. NCHS Data Brief. 2017;289:1–8.

    Google Scholar 

  10. Zhao B, Jose PO, Pu J, et al. Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern California 2010-2012. Am J Hypertens. 2015;28(5):631–9.

    Article  CAS  PubMed  Google Scholar 

  11. Sorlie PD, Allison MA, Avilés-Santa ML, et al. Prevalence of hypertension, awareness, treatment, and control in the Hispanic community health study/study of Latinos. Am J Hypertens. 2014;27(6):793–800.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006;24(2):215–33.

    Article  CAS  PubMed  Google Scholar 

  13. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006;144(7):485–95.

    Article  PubMed  Google Scholar 

  14. Krousel-Wood M, Thomas S, Muntner P, Morisky D. Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004;19(4):357–62.

    Article  PubMed  Google Scholar 

  15. In: Colten HR, Altevogt BM, eds. Sleep disorders and sleep deprivation: an unmet public health problem. Washington (DC), 2006.

  16. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9–17.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zamarrón C, Valdés Cuadrado L, Álvarez-Sala R. Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea syndrome. Pulmonary Medicine. 2013;2013:521087.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jean-Louis G, Zizi F, Clark LT, et al. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med. 2008;4(3):261–72.

    PubMed  PubMed Central  Google Scholar 

  19. Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–7.

    Article  CAS  PubMed  Google Scholar 

  20. Garaulet M, Ortega FB, Ruiz JR, Rey-López JP, Béghin L, Manios Y, et al. Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes. 2011;35(10):1308–17.

    Article  CAS  Google Scholar 

  21. Riegel B, Moelter ST, Ratcliffe SJ, Pressler SJ, de Geest S, Potashnik S, et al. Excessive daytime sleepiness is associated with poor medication adherence in adults with heart failure. J Card Fail. 2011;17(4):340–8.

    Article  PubMed  Google Scholar 

  22. Marcus JA, Pothineni A, Marcus CZ, Bisognano JD. The role of obesity and obstructive sleep apnea in the pathogenesis and treatment of resistant hypertension. Curr Hypertens Rep. 2014;16(1):411.

    Article  PubMed  Google Scholar 

  23. Goncalves SC, Martinez D, Gus M, et al. Obstructive sleep apnea and resistant hypertension: a case-control study. Chest. 2007;132(6):1858–62.

    Article  PubMed  Google Scholar 

  24. Demede M, Pandey A, Zizi F, et al. Resistant hypertension and obstructive sleep apnea in the primary-care setting. Int J Hypertens. 2011;2011:340929.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 2018;71(6):e13-e115.

  26. •• Bhandari SK, Shi J, Molnar MZ, et al. Comparisons of sleep apnoea rate and outcomes among patients with resistant and non-resistant hypertension. Respirology. 2016;21(8):1486–92. This is one of two new original research manuscripts to describe the association of obstructive sleep apnea defined using clinical diagnosis codes with hypertension in a large managed care system.

    Article  PubMed  Google Scholar 

  27. •• Johnson DA, Thomas SJ, Abdalla M, et al. Association between sleep apnea and blood pressure control among blacks: Jackson Heart Sleep Study. Circulation. 2018;. This is one of two new original research studies to describe the association of obstructive sleep apnea as diagnosed using a type 3 apnea screening device with hypertension in a cohort study comprised exclusively of African Americans.

  28. Carnethon MR, Pu J, Howard G, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136(21):e393–423.

    Article  PubMed  Google Scholar 

  29. Alajmi M, Mulgrew AT, Fox J, Davidson W, Schulzer M, Mak E, et al. Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea: a meta-analysis of randomized controlled trials. Lung. 2007;185(2):67–72.

    Article  CAS  PubMed  Google Scholar 

  30. Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin sleep cohort study. Sleep. 2008;31(6):795–800.

    Article  PubMed  PubMed Central  Google Scholar 

  31. • Liu L, Cao Q, Guo Z, Dai Q. Continuous positive airway pressure in patients with obstructive sleep apnea and resistant hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich). 2016;18(2):153–8. This meta-analysis of five studies describes a positive association of treatment of obstructive sleep apnea with 24-hour blood pressure values.

    Article  Google Scholar 

  32. • Lei Q, Lv Y, Li K, Ma L, du G, Xiang Y, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 2017;43(5):373–9. This meta-analysis that includes six studies that describe a positive association of treatment of obstructive sleep apnea with 24-hour blood pressure parameters.

    Article  Google Scholar 

  33. Thomas SJ, Calhoun D. Sleep, insomnia, and hypertension: current findings and future directions. Journal of the American Society of Hypertension : JASH. 2017;11(2):122–9.

    Article  PubMed  Google Scholar 

  34. Jarrin DC, Alvaro PK, Bouchard MA, Jarrin SD, Drake CL, Morin CM. Insomnia and hypertension: a systematic review. Sleep Med Rev. 2018;41:3–38.

    Article  PubMed  Google Scholar 

  35. Egan KJ, Knutson KL, Pereira AC, von Schantz M. The role of race and ethnicity in sleep, circadian rhythms and cardiovascular health. Sleep Med Rev. 2017;33:70–8.

    Article  PubMed  Google Scholar 

  36. Czeisler CA, Duffy JF, Shanahan TL, et al. Stability, precision, and near-24-hour period of the human circadian pacemaker. Science. 1999;284(5423):2177–81.

    Article  CAS  PubMed  Google Scholar 

  37. Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JAE, Speizer FE, et al. Prospective study of shift work and risk of coronary heart disease in women. Circulation. 1995;92(11):3178–82.

    Article  CAS  PubMed  Google Scholar 

  38. Chung MH, Kuo TB, Hsu N, et al. Sleep and autonomic nervous system changes - enhanced cardiac sympathetic modulations during sleep in permanent night shift nurses. Scand J Work Environ Health. 2009;35(3):180–7.

    Article  PubMed  Google Scholar 

  39. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163(2):205–9.

    Article  PubMed  Google Scholar 

  40. Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012;345:e4800.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Scheer FA, Hilton MF, Mantzoros CS, et al. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A. 2009;106(11):4453–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Knutson KL, Van Cauter E, Rathouz PJ, et al. Association between sleep and blood pressure in midlife: the CARDIA sleep study. Arch Intern Med. 2009;169(11):1055–61.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Grandner MA, Perlis ML. Short sleep duration and insomnia associated with hypertension incidence. Hypertens Res. 2013;36(11):932–3.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015;66:143–72.

    Article  PubMed  Google Scholar 

  45. Seravalle G, Mancia G, Grassi G. Sympathetic nervous system, sleep, and hypertension. Curr Hypertens Rep. 2018;20(9):74.

    Article  PubMed  Google Scholar 

  46. Buford TW. Hypertension and aging. Ageing Res Rev. 2016;26:96–111.

    Article  PubMed  PubMed Central  Google Scholar 

  47. • St-Onge MP, Grandner MA, Brown D, et al. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2016;134(18):e367–e86. This is a scientific statement from the American Heart Association describing the correlation of multiple domains of sleep health with cardiovascular diseases, including a description of mechanisms.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Tan X, Chapman CD, Cedernaes J, Benedict C. Association between long sleep duration and increased risk of obesity and type 2 diabetes: a review of possible mechanisms. Sleep Med Rev. 2018;40:127–34.

    Article  PubMed  Google Scholar 

  49. Spiegel K, Tasali E, Penev P, Cauter EV. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141(11):846–50.

    Article  PubMed  Google Scholar 

  50. Chaput JP. Sleep patterns, diet quality and energy balance. Physiol Behav. 2014;134:86–91.

    Article  CAS  PubMed  Google Scholar 

  51. Atkinson G, Davenne D. Relationships between sleep, physical activity and human health. Physiol Behav. 2007;90(2–3):229–35.

    Article  CAS  PubMed  Google Scholar 

  52. •• McEwen BS, Karatsoreos IN. Sleep deprivation and circadian disruption: stress, allostasis, and allostatic load. Sleep Med Clin. 2015;10(1):1–10. This is the first published randomized controlled trial testing whether an intervention for poor self-reported sleep was associated with blood pressure lowering. While the study showed positive associations on sleep, there was no difference in blood pressure.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Foster RG, Peirson SN, Wulff K, et al. Sleep and circadian rhythm disruption in social jetlag and mental illness. Prog Mol Biol Transl Sci. 2013;119:325–46.

    Article  PubMed  Google Scholar 

  54. McGrath ER, Espie CA, Power A, et al. Sleep to lower elevated blood pressure: a randomized controlled trial (SLEPT). Am J Hypertens. 2017;30(3):319–27.

    Article  PubMed  Google Scholar 

  55. Carnethon MR, De Chavez PJ, Zee PC, et al. Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago area sleep study. Sleep Med. 2016;18:50–5.

    Article  PubMed  Google Scholar 

  56. Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med. 2016;18:7–18.

    Article  PubMed  Google Scholar 

  57. Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72(5):e53–90.

    Article  CAS  PubMed  Google Scholar 

  58. Chen X, Wang R, Zee P, et al. Racial/ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep. 2015;38(6):877–88.

    PubMed  PubMed Central  Google Scholar 

  59. Rasmussen-Torvik LJ, De Chavez PJ, Kershaw KN, et al. The mediation of racial differences in hypertension by sleep characteristics: Chicago area sleep study. Am J Hypertens. 2016:hpw093.

  60. Curtis DS, Fuller-Rowell TE, El-Sheikh M, et al. Habitual sleep as a contributor to racial differences in cardiometabolic risk. Proc Natl Acad Sci U S A. 2017;114(33):8889–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA

    Mercedes R. Carnethon

  2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Dayna A. Johnson

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  1. Mercedes R. Carnethon
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Correspondence to Mercedes R. Carnethon.

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Carnethon, M.R., Johnson, D.A. Sleep and Resistant Hypertension. Curr Hypertens Rep 21, 34 (2019). https://doi.org/10.1007/s11906-019-0941-z

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