Resistant Hypertension and Obstructive Sleep Apnea
Is There a Specific Indication for Endovascular Renal Denervation?
See related article, pp 381–390
Despite current knowledge on the management of hypertension and the availability of multiple potent antihypertensive drugs, hypertension remains poorly controlled worldwide, and its prevalence is increasing because of the aging of populations and the obesity epidemic.1 Part of the patients have resistant hypertension (RHTN) to at least a triple antihypertensive therapy including a diuretic.2 Aging, male gender, black ethnicity, blood pressure (BP) at detection of hypertension, as well as obesity, diabetes mellitus, a Framingham 10-year coronary risk >20%, chronic kidney disease, and the presence of target organ damage are significantly associated with RHTN.2 In addition, obstructive sleep apnea (OSA) often associated with hypertension particularly in obese patients, is about almost 4× more frequent in patients with RHTN.2 Its pathophysiology includes sympathetic overdrive, aldosterone excess3 as well as possible fluid retention and its nocturnal rostral redistribution from the legs, where it may narrow the upper airway and increase its collapsibility, predisposing to OSA during sleep.4
The treatment strategy in RHTN is based on antihypertensive drug escalation, including aldosterone antagonists as fourth line treatment,5 …