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Difficult to treat hypertension has been defined as elevated blood pressure (BP) despite attempting lifestyle modifications and multiple combinations of pharmacotherapy. Secondary causes for treatment resistance must be explored. Obstructive sleep apnea (OSA) is an overlooked disease process that explains this phenomenon.
All patients in this study were given a 24-hour ambulatory blood pressure monitor (ABP). The patients were outfitted with a suitably sized BP cuff along with a blood pressure monitor to record data over a 24 hour period. All patients were screened for sleep apnea using a NOX sleep monitoring device. The NOX device is a portable respiratory sleep monitor that provides sleep diagnostics. The NOX device records data including AHI (apnea-hypopnea index) and ODI (oxygen desaturation index). Patient biometric data was obtained in the forms of neck and waist circumference as well as height and weight values.
In this study, 34 patients were assessed for hypertension and OSA using the methods described. Of these patients, 76% recorded nocturnal elevations of BP. Furthermore, 92% of these patients were confirmed to have OSA using the NOX device. Further correlation with patient biometrics show that of the 26 patients, 10 showed a neck circumference greater than 17 inches and 20 showed a waist circumference greater than 40 inches. These results correlate with a body habitus typical of an OSA patient.
Most people at some point in their life will require some form of anti-hypertensive treatment. It is well established that OSA is a secondary cause of hypertension. Most of the patients showed a nocturnal elevation of BP. Nocturnal elevation of BP is the inability to show a decrease of at least 10% of the daytime average BP. A lack of nocturnal dip indicates nocturnal hypertension. The finding of nocturnal hypertension indicates a high probability of OSA. The diagnosis of OSA would likely be the secondary cause in the difficult to treat hypertensive patient. The data obtained from the NOX device allows for accurate screening of sleep apnea patients who can be further referred for a sleep study or be ruled out of needing further investigation.
Poster Hall, Hall F
Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Hypertension 3
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1233-442
- 2019 American College of Cardiology Foundation