Obstructive Sleep Apnea and Arterial Hypertension: Implications of Treatment Adherence

Abstract

Purpose of review: This review seeks to present an overview of the recent literature on the importance of CPAP and antihypertensive treatment adherence in blood pressure control of hypertensive patients, especially those with obstructive sleep apnea.

Recent findings: Although it is unquestionable that a good adherence to CPAP and antihypertensive drugs is crucial to improvements in sleep-related symptoms, blood pressure levels (even the modest reductions of 2-2.5 mmHg achieved by CPAP treatment) and future cardiovascular risk, this adherence decreases over time, despite efforts made toward behavioral intervention and monitoring. Curiously, although taking a drug would seem to be easier than the use of CPAP treatment, based on current information, it seems that the compliance with drug treatment in hypertensive subjects is not better than that achieved with CPAP treatment in OSA patients with hypertension. However, some studies have shown some phenotypes of hypertensive and OSA patients with good adherence and better hypertensive effect, such as those with uncontrolled blood pressure (resistant and refractory hypertension), severe forms of sleep apnea, and more sleep-related symptoms, especially a higher degree of diurnal hypersomnia. The positive effect of antihypertensive drugs and CPAP treatment on blood pressure levels depends on the degree of treatment adherence, especially in forms of uncontrolled hypertension, but this adherence decreases over time. Educational programs and new devices are needed to improve adherence to treatment in these patients, along with fuller understanding of the different patterns and phenotypes of non-adherence.

Keywords: Adherence; Compliance; Continuous positive airway pressure; Hypertension; Refractory hypertension; Resistant hypertension; Sleep apnea.