Obstructive sleep apnea is more severe in men but not women with refractory hypertension compared with controlled resistant hypertension.
Obstructive sleep apnea is more severe in men but not women with refractory hypertension compared with controlled resistant hypertension.
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与控制性难治性高血压相比，难治性高血压患者的阻塞性睡眠呼吸暂停在男性中更为严重，但在女性中则不然。
DOI：
10.1097/hjh.0000000000002631
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发表时间：
2021
影响因子：
4.9
通讯作者：
Calhoun,David
中科院分区：
文献类型：
--
作者：
Thomas,SJustin;Siddiqui,Mohammed;Judd,Eric;Moore,David;Harding,SusanM;Oparil,Suzanne;Calhoun,David
目的：阻塞性睡眠呼吸暂停（OSA）与难治性高血压（RHTN）相关，并可能导致难治性高血压（RfHTN）。本研究的目的是验证RfHTN患者与对照RHTN患者相比有更严重OSA的假设。方法：在阿拉巴马大学伯明翰高血压诊所进行RHTN评估和治疗的患者（n= 187）， RHTN定义为血压（BP）不受控制（收缩压≥130 mmHg或舒张压≥80 mmHg），尽管使用了至少三种降压药物，包括利尿剂，在完成至少三次随访临床访问后入组。RfHTN被定义为不受控制的高血压，尽管使用了五种或更多种不同类别的降压药，包括长效噻嗪类利尿剂和矿皮质激素受体拮抗剂。入组后，所有患者（n= 130）在正常夜间使用持续气道正压通气期间完成24小时动态血压测量和夜间诊断性多导睡眠检查。分析了RfHTN患者与对照RHTN患者的OSA严重程度和相关睡眠特征。结果：130例患者中，37例（28.5%）有RfHTN， 93例（71.5%）RHTN得到控制。在未经调整的分析中，RfHTN患者与对照RHTN患者在OSA严重程度、氧饱和度或低氧血症时间方面无显著差异（P < 0.05）。RfHTN患者的OSA严重程度高于RHTN控制组（P= 0.044）。在校正分析中，OSA严重程度与性别相关（P< 0.0001），但与高血压表型无关（P= 0.17）。结论：OSA严重程度对男性RfHTN状态有影响，而对女性无影响。难治性高血压（RfHTN）是一种抗高血压治疗失败的极端表型，它被定义为尽管使用了五种或更多种不同类别的降压药，包括长效噻嗪类利尿剂（如氯噻酮）和矿皮质激素受体拮抗剂（如旋内酯或依普利酮）[1]，但血压仍未得到控制。据估计，在未控制的顽固性高血压（RHTN）患者中，RfHTN的患病率不到5%。RHTN的定义是，尽管使用了三种或更多种降压药（包括利尿剂）治疗，但血压未控制[2-5]。RHTN还包括使用四种或四种以上降压药控制血压（即控制RHTN）的个体。与对照RHTN患者相比，RfHTN患者有充血性心力衰竭或慢性肾脏疾病病史的可能性更大[1,3]。
Objectives:Obstructive sleep apnea (OSA) is associated with treatment-resistant hypertension (RHTN) and may contribute to refractory hypertension (RfHTN). The objective of the current study was to test the hypothesis that patients with RfHTN have more severe OSA compared with patients with controlled RHTN.Methods:Patients (n= 187) referred to the University of Alabama at Birmingham Hypertension Clinic for evaluation and treatment of RHTN, defined as uncontrolled blood pressure (BP)(SBP≥ 130 mmHg or DBP≥ 80 mmHg) despite the use of at least three antihypertensive medications including a diuretic, were enrolled following completion of at least three follow-up clinic visits. RfHTN was defined as uncontrolled high BP despite treatment with five or more antihypertensive agents of different classes, including a long-acting thiazide-type diuretic and a mineralocorticoid receptor antagonist. Following enrollment, all patients (n= 130) completed 24-h ambulatory BP measurement and overnight diagnostic polysomnography during normal nightly use of continuous positive airway pressure. Analyses examined the severity of OSA and related sleep characteristics among patients with RfHTN versus controlled RHTN.Results:Of the 130 evaluated patients, 37 (28.5%) had RfHTN and 93 (71.5%) had controlled RHTN. In unadjusted analyses, there was not a significant difference in OSA severity, oxygen saturation, or hypoxemia time in patients with RfHTN versus controlled RHTN (P> 0.05). Men with RfHTN had more severe OSA compared with men with controlled RHTN (P= 0.044). In adjusted analyses, OSA severity was associated with sex (P< 0.0001), but not hypertension phenotype (P= 0.17).Conclusion:The severity of OSA may contribute to RfHTN status in men but not women.INTRODUCTIONRefractory hypertension (RfHTN), an extreme phenotype of antihypertensive treatment failure, is defined as uncontrolled high blood pressure (BP) despite treatment with five or more antihypertensive agents of different classes, including a long-acting thiazide-type diuretic (ie chlorthalidone) and a mineralocorticoid receptor antagonist (MRA)(ie spironolactone or eplerenone)[1]. The prevalence of RfHTN is estimated to be less than 5% of patients with uncontrolled resistant hypertension (RHTN), defined as uncontrolled BP despite treatment with three or more antihypertensive agents, including a diuretic [2–5]. RHTN also includes individuals whose BP is controlled with the use of four or more antihypertensive agents (ie controlled RHTN)[5]. Compared with patients with controlled RHTN, patients with RfHTN are more likely to have a history of congestive heart failure or chronic kidney disease [1, 3].