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Association between arterial stiffness and sleep apnoea in patients with resistant hypertension


Resistant Hypertension (RHT) is associated with a higher risk of Obstructive Sleep Apnoea (OSA). OSA and aortic stiffness (AS) measured by Pulse Wave Velocity (PWV) are independent risk factors for cardiovascular events. We assessed, in a cross-sectional study, the association between AS measured by PWV and OSA severity in patients with RHT. All patients were submitted to polysomnography, PWV measure and 24 h ABPM. Bivariate analysis compared patients with and without moderate/severe OSA. Multivariate analysis was performed to assess the independent correlates of moderate/severe OSA. A total of 376 patients were included, 31% were men with a mean age of 63 ± 10 years. Moderate/severe OSA was diagnosed in 214 patients (57%), 63 patients (17%) presented AS. Uncontrolled ABPM (true RHT) was found in 215 patients (57.2%) and among them 113 were diagnosed with moderate/severe OSA. Evaluating AS in patients with mild, moderate and severe apnoea, we observed a progressive increase in PWV (8.19 ± 1.55, 8.51 ± 1.84, 8.67 ± 1.68, respectively). Classifying them in 2 groups: (1) without apnoea/mild apnoea and (2) moderate/severe apnoea, we found higher values in group 2 (8.21 ± 1.52 m/s vs. 8.60 ± 1.75 m/s, p = 0.02), especially among true RHT patients (8.28 ± 1.62 vs. 8.81 ± 1.86, p = 0.029), women (8.13 ± 1.49 vs. 8.55 ± 1.73, p = 0.036), and uncontrolled nocturnal systolic BP (8.49 ± 1.63 vs. 8.58 ± 1.78, p = 0.04). In conclusion, in this RHT cohort, although with borderline results, the more severe the apnoea, the greater the arterial stiffness, mainly among women, true RHT and patients with an adverse nocturnal BP profile.

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Fig. 1: Flowchart study.
Fig. 2: Measurement of pulse wave velocity according apnoea severity and ABPM control.
Fig. 3: Measurement of pulse wave velocity according to apnoea severity and gender.
Fig. 4: Measurement of pulse wave velocity according apnoea severity and nocturnal systolic blood pressure control.


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We are grateful to all professionals and participants of the study. This paper was not funded.

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Authors and Affiliations



ESM conceived and designed the study. CNR, AHC, AFC, BC and FOCC followed-up the patients and obtained the data. CNR performed the PWVcf examinations. EMS, FS and CNR drafted the manuscript. EMS analysed the data. All authors helped interpret the results, reviewed the manuscript critically and substantially for important intellectual content, and approved this final version.

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Correspondence to Fabio de Souza.

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The authors declare no competing interests.

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This study was approved by the Ethics Committee of Hospital Universitário Clementino Fraga Filho and written informed consent was obtained from all participants

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Roderjan, C.N., de Hollanda Cavalcanti, A., Cortez, A.F. et al. Association between arterial stiffness and sleep apnoea in patients with resistant hypertension. J Hum Hypertens (2022).

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