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Uncontrolled hypertension and obstructive sleep apnea in the elderly


Obstructive sleep apnea (OSA) and hypertension may have common pathophysiological mechanisms. OSA leads to sympathetic hyperactivity, oxidative stress, endothelial damage, which may contribute to the severity of hypertension.


We hypothesized that elderly individuals with more severe OSA are more likely to have uncontrolled hypertension. To test this hypothesis we conducted a case-control study comparing the apnea-hypopnea index of elderly patients with uncontrolled hypertension with that of controls.


Physically independent subjects of aged 65 to 80 years of both sexes were included. They underwent out-of-center polysomnography and ambulatory blood pressure monitoring (ABPM). A 24-hour blood pressure >130/85 mm Hg was considered as uncontrolled hypertension. Individuals without hypertension or with untreated hypertension were included as controls.


A total of 143 subjects, aged 70±4 years, 54% male, 33% obese and 10% non-white skin color were included in the present study. In the sample, 17% were non- hypertensive, 10% non-medicated, 34% with controlled hypertension and 39% with uncontrolled hypertension. The apnea hypopnea index (AHI) was higher in the uncontrolled hypertension group than in the others groups (P=0.04). In the binary logistic model, the presence of uncontrolled hypertension increases almost three times the odds of AHI >15, i.e., moderate-severe OSA. The model that explains about 14% of the variance includes also the classical OSA confounders, sex, age and obesity, plus non-white skin color.


OSA continues as a neglected cause of hypertension in the elderly. The present results should be a call to action. Considering OSA the more common cause of uncontrolled hypertension may be life-saving since hypertension is the main cause of cardiovascular disease and mortality.


Elderly, Hypertension, Uncontrolled hypertension, Obstructive sleep apnea, Ambulatory blood pressure monitoring.


Área Clínica


Micheli Fagundes, Renata Schenkel Kaminski, Chaiane Facco Piccin, Roberto Pacheco da Silva, Emerson Martins, Yasmin de Freitas Dias, Laura Martinewski de Oliveira, Denis Martinez