HealthDay News — There is a strong association between severe untreated obstructive sleep apnea (OSA) and resistant elevated blood pressure (BP), despite treatment with an aggressive antihypertensive medication regimen, according to a study published in the Journal of Clinical Sleep Medicine.

Harneet K. Walia, MD, from the Cleveland Clinic, and colleagues analyzed baseline data for 284 participants in the  Heart Biomarker Evaluation in Apnea Treatment trial.

An intensive antihypertensive regimen (IAR) is defined as taking three or more antihypertensives, including a diuretic. BP was characterized as controlled BP (BP <130/80 mm Hg), uncontrolled elevated BP (BP ≥130/80 mm Hg not on IAR) and resistant elevated BP (BP ≥130/80 mm Hg despite IAR).

Severe OSA was present in 23.6% of patients. Overall, 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP.

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Resistant elevated BP was more prevalent in those with severe versus moderate OSA (58.3% vs. 28.6%; P=0.01) among patients prescribed an intensive antihypertension regimen. There were four-fold higher adjusted odds of resistant elevated BP among participants with severe OSA, a finding not reproduced in the absence of IAR use.

“Our findings suggest that severe obstructive sleep apnea contributes to poor blood pressure control despite aggressive medication use,” Walia said in a statement. “This is an important finding from a clinical perspective as poor blood pressure control in patients taking multiple antihypertensive medications makes them particularly vulnerable to increased cardiovascular risk.”

Several authors disclosed financial ties to the pharmaceutical industry.


  1. Walia HK, et al. Journal of Clinical Sleep Medicine.