Khaled Abdel-Kader
Last active: 11/29/2018

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

Abdel-Kader K, Dohar S, Shah N, Jhamb M, Reis SE, Strollo P, Buysse D, Unruh ML
J Hypertens. 2012 30 (5): 960-966

PMID: 22388231 · PMCID: PMC3771863 · DOI:10.1097/HJH.0b013e328351d08a

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.

MeSH Terms (15)

Aged Antihypertensive Agents Blood Pressure Blood Pressure Monitoring, Ambulatory Case-Control Studies Drug Resistance Female Humans Hypertension Kidney Failure, Chronic Male Middle Aged Polysomnography Sleep Sleep Apnea, Obstructive

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