By Domenic Sica, Peter P. Toth
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Sample text
Recently, three additional studies have also demonstrated that morning BP surge is a risk factor for both CV events and mortality independent of 24-h BP [9–11]. Second, the morning BP surge can potentiate target organ injury. The morning BP surge is associated both with hypertensive heart disease and with subclinical vascular diseases from small artery remodeling to instability of large artery atherosclerotic plaques [12]. 1) [13]. The morning BP surge could not only be the leading cause of vascular disease but also be a result of remodeling of small resistance arteries; thus, a cause and effect relationship.
Likewise, given the strong association between OSA and resistant hypertension, CPAP may be particularly beneficial in reducing the likelihood of developing resistance to antihypertensive therapies. Each of these possibilities needs testing by prospective studies. EFFECT OF HYPERTENSION TREATMENT ON OSA Different antihypertensive drug classes may have varying effects in patients with OSA, but there is little data comparing drug classes [1]. A comparison of the effects of five commonly used antihypertensive drugs (atenolol, amlodipine, enalapril, losartan, and hydrochlorothiazide) on BP and sleep architecture showed no effect on the severity of OSA [41].
Contrasting effects of hypoxia and hypercapnia on ventilation and sympathetic activity in humans. J Appl Physiol 1989; 67:2101–2106. Somers VK, Mark AL, Zavala DC, Abboud FM. Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans. J Appl Physiol 1989; 67:2095–2100. Kapa S, Kuniyoshi FH, Somers VK. Sleep apnea and hypertension: interactions and implications for management. Hypertension 2008; 51:605–608. Shamsuzzaman ASM, Gersh BJ, Somers VK. Obstructive sleep apnea.