Sleep Apnea May Increase Odds of Resistant Elevated Blood Pressure

(HealthDay News) -— There is a strong association between severe untreated obstructive sleep apnea and resistant elevated blood pressure, despite treatment with an aggressive antihypertensive medication regimen, according to a study published in the Journal of Clinical Sleep Medicine.

Harneet K. Walia, MD, from the Cleveland Clinic, and colleagues analyzed baseline data for 284 participants in the multisite, randomized controlled Heart Biomarker Evaluation in Apnea Treatment trial. 

Taking three or more antihypertensives, including a diuretic, defined an intensive antihypertensive regimen (IAR). Blood pressure (BP) was characterized as controlled BP (BP <130/80 mm Hg), uncontrolled elevated BP (BP ≥130/80 mm Hg not on IAR) and resistant elevated BP (BP ≥130/80 mm Hg despite IAR).

The researchers found that 23.6% of patients had severe obstructive sleep apnea, 61.6% had controlled BP, 28.5% had uncontrolled elevated BP and 9.9% had resistant elevated BP. 

Resistant elevated BP was more prevalent in those with severe vs.moderate obstructive sleep apnea (58.3% vs. 28.6%; P=.01), among those prescribed IAR. There were four-fold higher adjusted odds of resistant elevated BP among participants with severe obstructive sleep apnea, a finding not reproduced in the absence of IAR use.

“Our findings suggest that severe obstructive sleep apnea contributes to poor blood pressure control despite aggressive medication use,” Walia said in a statement. 

“This is an important finding from a clinical perspective as poor blood pressure control in patients taking multiple antihypertensive medications makes them particularly vulnerable to increased cardiovascular risk.”

Several authors disclosed financial ties to the pharmaceutical industry.


  1. Walia HK et al. J Clin Sleep Med. 2014;doi:10.5664/jcsm.3946.