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Resistant Hypertension and Sleep Apnea: Pathophysiologic Insights and Strategic Management

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Abstract

Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep apnea–associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiologic data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered.

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Abbreviations

ALLHAT:

Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

ASCOT-BPLA:

Blood Pressure Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial

SHHS:

Sleep Heart Health Study

WSCS:

Wisconsin Sleep Cohort Study

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Disclosure

Conflicts of interest: S.K. Williams: none; J. Ravenell: none; G. Jean-Louis: none; F. Zizi: none; J.A. Underberg: has received honoraria for speaking from Forest Pharmaceuticals and from Daiichi Sankyo. Potential research grants are pending from Forest Pharmaceuticals; S.I. McFarlane: none; G. Ogedegbe: none.

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Authors and Affiliations

  1. Center for Healthful Behavior Change, Division of General Internal Medicine, New York University School of Medicine, 423 East 23rd Street #15-168N, New York, NY, 10010, USA

    Stephen K. Williams, Joseph Ravenell & Gbenga Ogedegbe

  2. Center for Complementary and Integrative Medicine and Division of General Internal Medicine, Weill Medical College of Cornell University, New York, NY, 10021, USA

    Stephen K. Williams

  3. Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Girardin Jean-Louis, Ferdinand Zizi & Samy I. McFarlane

  4. Sleep Disorders Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Girardin Jean-Louis & Ferdinand Zizi

  5. NYU Center for Cardiovascular Prevention, Division of General Internal Medicine, New York University Medical School, New York, NY, USA

    James A. Underberg

  6. Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, State University of New York, Downstate Medical Center and Kings County Hospital Center, 450 Clarkson Avenue, Box 50, Brooklyn, NY, 11203-2098, USA

    Samy I. McFarlane

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Correspondence to Stephen K. Williams.

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Williams, S.K., Ravenell, J., Jean-Louis, G. et al. Resistant Hypertension and Sleep Apnea: Pathophysiologic Insights and Strategic Management. Curr Diab Rep 11, 64–69 (2011). https://doi.org/10.1007/s11892-010-0161-z

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