Resistant Hypertension in Chronic Kidney Disease

213

Conclusions

A large body of evidence supports the role of OSA as an independent factor in the
pathogenesis of daytime hypertension and appears to represent the single greatest
modifiable factor in patients with resistant hypertension specifically. The relation-
ship between OSA and hypertension persists even after controlling for obesity as a
modifier of the OSA-hypertension association. CPAP reduces blood pressure to a
modest degree in patients with resistant hypertension but has a more potent effect in
this population than the more general population of hypertensive individuals.
Greater CPAP adherence may be expected to result in larger BP reductions in a
dose-response fashion. Given that even mild reductions in blood pressure may result
significant reductions in cardiovascular risk, we recommend aggressive screening
for OSA in all patients with resistant hypertension, including the elderly. Sleep cen-
ters should generally have a low threshold for testing such patients, even in the
presence of minimal daytime symptoms, since treatment is generally well
tolerated.

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13 Obstructive Sleep Apnea and Resistant Hypertension