Journal of Hypertension

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Journal of Hypertension:
Original papers: Clinical aspects

High prevalence of unrecognized sleep apnoea in drug-resistant hypertension

Logan, Alexander G.a,c; Perlikowski, Sandra M.a; Mente, Andrewa; Tisler, Andrasa; Tkacova, Ruzenab; Niroumand, Mitrab; Leung, Richard S. T.b; Bradley, T. Douglasb,c

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Objectives : To determine the prevalence of obstructive sleep apnoea (OSA) in adult patients with drug-resistant hypertension, a common problem in a tertiary care facility.

Design : Cross-sectional study.

Setting : University hypertension clinic.

Patients and methods : Adults with drug-resistant hypertension, defined as a clinic blood pressure of 140/90 mmHg, while taking a sensible combination of three or more antihypertensive drugs, titrated to maximally recommended doses. Each of the 41 participants completed an overnight polysomnographic study and all but two had a 24 h ambulatory blood pressure measurement.

Results : Prevalence of OSA, defined as an apnoea-hypopnoea index of 10 obstructive events per hour of sleep, was 83% in the 24 men and 17 women studied. Patients were generally late middle-aged (57.2 ± 1.6 years, mean ± SE), predominantly white (85%), obese (body mass index, 34.0 ± 0.9 kg/m2) and taking a mean of 3.6 ± 0.1 different antihypertensive medications daily. OSA was more prevalent in men than in women (96 versus 65%, P = 0.014) and more severe (mean apnoea–hypopnoea index of 32.2 ± 4.5 versus 14.0 ± 3.1 events/h, P = 0.004). There was no gender difference in body mass index or age. Women with OSA were significantly older and had a higher systolic blood pressure, lower diastolic blood pressure, wider pulse pressure and slower heart rate than women without OSA.

Conclusions : The extraordinarily high prevalence of OSA in these patients supports its potential role in the pathogenesis of drug-resistant hypertension, and justifies the undertaking of a randomized controlled trial to corroborate this hypothesis.

© 2001 Lippincott Williams & Wilkins, Inc.


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