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Obstructive Sleep Apnea is Associated with Higher Left Ventricle Hypertrophy Frequency in Patients with Resistant Hypertension.
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 (TOD) in patients with non-resistant hypertension (NRH) and in patients with RH.
To compare the presence of left ventricular hypertrophy (LVH), one of the major TOD, in patients with NRH and RH according to the presence of OSA.
We recruited consecutive cases of adult patients with NRH and RH (as defined by standardized criteria) from our Hypertension outpatient unit. To avoid potential confounders, we excluded patients with diabetes, smokers or significant chronic kidney disease (estimated glomerular filtration rate <45 mL/min). All patients underwent sleep monitoring with portable sleep monitor (Embletta Gold®) for the diagnosis of OSA. We defined OSA by an apnea-hypopnea index (AHI) ≥15 events / hour. The patients also performed other procedures including office blood pressure (BP), ambulatory BP monitoring (ABPM) and transthoracic echocardiography. After performing the proposed procedures, the patients were divided into four groups: patients with NRH without OSA (NRH-OSA); patients with NRH with OSA (NRH+OSA); patients with RH without OSA (RH-OSA) and patients with RH with OSA (RH+OSA). All analyses were performed without previous access to OSA and RH status. We compared the BP and echocardiograph data using analysis of variance (ANOVA).
We initially screened 248 patients. So far, 50 subjects (mean age: 54±8 years old, 60% female, body mass index: 29.8±4.0 kg/m²) were included in the analysis. As expected, patients with RH took more anti-hypertensive medications than NRH but no significant differences were observed in patients with and without OSA. In patients with RH (n=24), the presence of OSA (58%) was associated with a strong tendency towards a higher frequency of LVH (RH+OSA: 92% vs. RH-OSA: 50%, p=0.05). This finding was not observed in patients with NRH (NRH+OSA: 31% vs. NRH-OSA: 33%, p=1.00). Data from office BP measurements and ABPM did not show significant differences in patients with and without OSA regardless of RH status.
Our preliminary data suggest that the presence of OSA may contribute to higher cardiac remodeling in patients with RH.
Obstructive Sleep Apnea, Hypertension, Target Organ Damage, Left Ventricular Hypertrophy, Blood Pressure.
Hospital das Clínicas de São Paulo - São Paulo - Brasil, Instituto do Coração de São Paulo - São Paulo - Brasil, Laboratório do Sono do Incor - São Paulo - Brasil
Mayara Longui Cabrini, Thiago A Macedo, Silvana de Barros, Indira F B Azam, Andrea Pio-Abreu, Giovanio V Silva, Luiz A Bortolotto, Geraldo Lorenzi-Filho, Luciano F Drager