Dados do Trabalho

Título

Obstructive Sleep Apnea and Hypertension-Mediated Organ Damage in Nonresistant and Resistant Hypertension

Introdução

Obstructive Sleep Apnea (OSA) is common in patients with hypertension, especially in those with Resistant Hypertension (RH). However, it is unclear whether OSA can contribute to target-organ damage in patients with non-resistant hypertension (NRH) and in patients with RH.

Objetivo

This study aims to evaluate the potential impact of OSA on Hypertension-Mediated Organ Damage (HMOD) in patients with NRH and RH.

Métodos

We included patients with hypertension without diabetes from a Tertiary Center to perform a clinical evaluation, a sleep study to define OSA (apnoea-hypopnoea index ≥15 events/h), and standard analysis of four HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [≥10 m/s], presence of retinopathy and nephropathy) in a blinded fashion. RH was diagnosed by uncontrolled blood pressure (BP) (≥140/90 mmHg) despite using at least three antihypertensive classes or patients with controlled BP using ≥4 classes at optimal doses. To avoid the white-coat effect, we performed an ambulatory BP monitoring to confirm the RH diagnosis.

Resultados

One-hundred patients were included in the analysis (mean age: 54±8 years, 65% female, body mass index: 30.4±4.5 kg/m²). OSA was detected in 52% of patients. In patients with NRH (n=53), the presence of OSA (52.8%) was not associated with increased frequency of HMOD. In contrast, among patients with RH, OSA (51.1%) was associated with an increased rate of LVH (RH-OSA: 61%; RH+OSA: 87%; p=0.049). Considering the total sample, logistic regression analysis showed that RH (OR: 8.43; 95% CI: 2.51-28.37; P<0.001) and OSA (OR: 4.67; 95% CI: 1.24-17.62; P=0.023) were independently associated with LVH. No significant associations were observed between OSA for arterial stiffness, retinopathy or nephropathy.

Conclusões

OSA is independently associated with LVH in RH, suggesting a potential role of OSA in the RH prognosis.

Palavras -chave

sleep apnea; heart; hypertension; resistant; target-organ damage.