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Obstructive Sleep Apnea and Arterial Hypertension: Implications of Treatment Adherence

Authors
  • Posadas, Tomás1
  • Campos-Rodriguez, Francisco2, 3
  • Sapiña-Beltrán, Esther3, 4
  • Oscullo, Grace1
  • Torres, Gerard3, 4
  • Martinez-Garcia, Miguel Angel1
  • 1 Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, Valencia, 46012, Spain , Valencia (Spain)
  • 2 Hospital Valme, IBiS, Seville, Spain , Seville (Spain)
  • 3 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain , Madrid (Spain)
  • 4 IRBLleida, Lleida, Cataluña, Spain , Lleida (Spain)
Type
Published Article
Journal
Current Hypertension Reports
Publisher
Springer-Verlag
Publication Date
Feb 03, 2020
Volume
22
Issue
2
Identifiers
DOI: 10.1007/s11906-020-1015-y
Source
Springer Nature
Keywords
License
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Abstract

Purpose of ReviewThis review seeks to present an overview of the recent literature on the importance of CPAP and antihypertensive treatment adherence in blood pressure control of hypertensive patients, especially those with obstructive sleep apnea.Recent FindingsAlthough it is unquestionable that a good adherence to CPAP and antihypertensive drugs is crucial to improvements in sleep-related symptoms, blood pressure levels (even the modest reductions of 2–2.5 mmHg achieved by CPAP treatment) and future cardiovascular risk, this adherence decreases over time, despite efforts made toward behavioral intervention and monitoring. Curiously, although taking a drug would seem to be easier than the use of CPAP treatment, based on current information, it seems that the compliance with drug treatment in hypertensive subjects is not better than that achieved with CPAP treatment in OSA patients with hypertension. However, some studies have shown some phenotypes of hypertensive and OSA patients with good adherence and better hypertensive effect, such as those with uncontrolled blood pressure (resistant and refractory hypertension), severe forms of sleep apnea, and more sleep-related symptoms, especially a higher degree of diurnal hypersomnia.SummaryThe positive effect of antihypertensive drugs and CPAP treatment on blood pressure levels depends on the degree of treatment adherence, especially in forms of uncontrolled hypertension, but this adherence decreases over time. Educational programs and new devices are needed to improve adherence to treatment in these patients, along with fuller understanding of the different patterns and phenotypes of non-adherence.

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