Resistant Hypertension in Chronic Kidney Disease

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5

1.0

1.5

2.0

2.5

3.0

3.5

10 15 20 30 40 50
Apnoea-hypopnoea index

Odds ratio

Odds ratios
Wald 95% confidence intervals

60 70

Fig. 13.2 Incidence of hypertension over time in patients without OSA and untreated patients
with OSA of varying severities. Severity of OSA was defined by the apnea-hypopnea index (AHI)
as mild OSA (AHI 5.0–14.9), moderate OSA (AHI 15.0–29.9), and severe OSA (AHI ≥ 30) (From
Lavie et al. [ 14 ]; with permission)


Recurrent episodes of airway obstruction during sleep

Intermittent hypoxia/Sleep fragmentation
Hypercapnia

Chemoreflex activation
autonomic CV modulation

RAAS activity
Aldosterone
Sympathetic
activation
ROS, ET-1,
NOS blockade

Vascular tone hypertensive peak followingsudden recovery
of LV function

OSAs-related
myocardial damage
arterial stiffness, LVH

office BP and 24th, day and night-time ambulatory BP levels
Non dipping pattern of BP, nocturnal hypertension

Fluid retention

NO production
vasodilatation

Inflammation
Oxidative stress
Endothelial
dysfunction
Dysglycemia;insulin
and leptin resistance
Alterations in LV
mechanical properties

changes in pulmonary volume
intrathoracic pressures

Fig. 13.3 Mechanisms by which obstructive sleep apnea syndrome (OSAS) may contribute to
resistant hypertension (From Parati et al. [ 35 ]; with permission)


13 Obstructive Sleep Apnea and Resistant Hypertension

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