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J Hypertens. 2012 May;30(5):960-966. doi: 10.1097/HJH.0b013e328351d08a.

Resistant hypertension and obstructive sleep apnea in the setting of kidney disease.

Author information

1
Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA.
2
West Virginia University School of Medicine, Morgantown, WV.
3
Division of Cardiology, University of Pittsburgh, Pittsburgh PA.
4
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
5
Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
#
Contributed equally

Abstract

OBJECTIVES:

To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD).

METHODS:

We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study: 88 nondialysis-dependent CKD and 95 ESRD participants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP of at least 140/90  mmHg despite at least three antihypertensive drugs.

RESULTS:

Mean SBP of the CKD and ESRD groups were significantly higher than that of the non-CKD group [148.2 (23.8), 144.5 (26.7) vs. 132.2  mmHg (26.7), respectively; P < 0.0001] despite the use of more antihypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4, 22.6 vs. 6.7%, respectively; P < 0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. Although resistant hypertension was associated with severe sleep apnea in participants with ESRD [odds ratio (OR) 7.1, 95% confidence interval (CI) 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix.

CONCLUSION:

The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension-OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.

PMID:
22388231
PMCID:
PMC3771863
DOI:
10.1097/HJH.0b013e328351d08a
[Indexed for MEDLINE]
Free PMC Article
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