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International Journal of Hypertension
Volume 2013, Article ID 193010, 6 pages
Review Article

Resistant Hypertension and Obstructive Sleep Apnea

1Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland OR & Portland VA Medical Center, 3181 SW Sam Jackson Park Road, UHN67, Portland, Oregon 97239-3098, USA
2Division of Nephrology and Hypertension, Oregon Health & Science University, Portland OR & Portland VA Medical Center, Portland, OR 97239, USA

Received 28 February 2013; Revised 21 April 2013; Accepted 27 April 2013

Academic Editor: B. Waeber

Copyright © 2013 Akram Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hypertension (HTN) is a modifiable, highly prevalent risk factor for cardiovascular morbidity and renal dysfunction worldwide. In the United States, HTN affects one in three adults, contributes to one out of every seven deaths and to nearly half of all cardiovascular disease-related deaths. HTN is considered resistant when the blood pressure remains above goal despite lifestyle modification and administration of three antihypertensive agents of different classes including a diuretic. Large population-based studies have suggested that obstructive sleep apnea (OSA) is a risk factor for resistant HTN. The mechanism proposed is a pattern of intermittent hypoxia associated with hyperaldosteronism, increased sympathetic tone, endothelial dysfunction, and inflammation. In this review we discuss the association between OSA and resistant HTN, the physiologic mechanisms linking OSA with resistant HTN, and the effect of continuous positive airway pressure therapy (CPAP) on blood pressure in patients with resistant HTN. While the reduction in blood pressure with CPAP is usually modest in patients with OSA, a decrease of only a few mmHg in blood pressure can significantly reduce cardiovascular risk. Patients presenting to a center specializing in management of hypertension should be screened and treated for OSA as a potentially modifiable risk factor.