Optimizing the Management of Uncontrolled/Resistant Hypertension. The Importance of Sleep Apnoea Syndrome

Introduction: Obstructive Sleep Apnoea (OSA) constitutes the most prevalent form of abnormal respiratory control during sleep in adults. Evidence linked OSA to cardiovascular disease, and the role of OSA in abnormal Blood Pressure (BP) control has been extensively studied. Although longitudinal trials suggest a causative role of OSA in the development of hypertension, the evidence is not fully consistent. Nasal continuous positive airway pressure (nCPAP) applied during sleep is well documented and a highly efficient therapeutic aid to eliminate OSA. It has been repeatedly shown that nCPAP-therapy is also associated with modest BP lowering effect in hypertensive OSA-patients, and the magnitude of the observed effect correlates with the severity of OSA. However, it is unlikely that nCPAP would normalize BP. Conclusion: There are few studies which tested the interplay between OSA, nCPAP and certain BPlowering drug classes. Angiotensin receptor blockers may show synergistic hypotensive effect with nCPAP, whereas mineralocorticoid receptor blocker has been shown to modestly attenuate the severity of OSA. Additionally, the application of chronotherapy may be of special use in such patients. The current evidence is sufficient to promote persistent and effective nCPAP-therapy as a standard in all eligible OSA-patients with difficult-to-control hypertension.