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Obstructive Sleep Apnea: The Most Common Secondary Cause of Hypertension Associated With Resistant Hypertension.
MedLine Citation:
PMID:  21968750     Owner:  NLM     Status:  Publisher    
Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9-14.2]; P<0.01), neck circumference ≥41 cm for women and ≥43 cm for men (odds ratio: 4.7 [95% CI: 1.3-16.9]; P=0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3-11]; P=0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.
Rodrigo P Pedrosa; Luciano F Drager; Carolina C Gonzaga; Marcio G Sousa; Lílian K G de Paula; Aline C S Amaro; Celso Amodeo; Luiz A Bortolotto; Eduardo M Krieger; T Douglas Bradley; Geraldo Lorenzi-Filho
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-3
Journal Detail:
Title:  Hypertension     Volume:  -     ISSN:  1524-4563     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Sleep Laboratory, Pulmonary Division, and Hypertension Unit, Heart Institute, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Pernambuco, Brazil; Department of Hypertension and Nephrology, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil; University of Toronto, Toronto, Ontario, Canada.
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