. Author manuscript; available in PMC: 2024 Jan 1.

Published in final edited form as: Int Forum Allergy Rhinol. 2023 Mar 30;13(7):1061–1482. doi: 10.1002/alr.23079

TABLE VII.A.4.

Association between OSA and refractory hypertension

Study	Year	LOE	Study design	Study groups	Clinical end-point	Conclusion
Pratt-Ubunama et al.⁶⁹⁹	2007	3b	Prospective, single-center, case–control study; all subjects underwent PSG (n = 46).	1) RHTN (n = 17). 2) Controls with suspected OSA (n = 29).	1. AHI. 2. PAC, renin concentration.	OSA was common in subjects with RHTN (85%) and was more common and severe in men vs. women. PAC (but not renin concentration) correlated with AHI.
Pedrosa et al.⁶⁷⁹	2011	3b	Prospective cohort, study conducted at two outpatient HTN units (n = 125).	Consecutive patients with RHTN.	Evaluation for secondary caiuses of HTN.	Moderate–severe OSA was the most common condition associated with RHTN, seen in 64% of subjects.
Walia et al.⁷⁰³	2014	3b	Secondary analysis of baseline data from the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) RCT (n = 284).	Subjects with HTN; 64% had OSA, 10% had RHTN.	Association between RHTN and OSA.	RHTN was more prevalent in subjects with severe vs. moderate OSA (58.3% vs. 28.6%, p = 0.01) who were prescribed antihypertensives; those with severe OSA had four-fold higher adjusted odds of RHTN (OR 4.1, 95% CI: 1.7–10.2).
Johnson et al.⁷⁰²	2018	3b	Analysis of data from the Jackson Heart Study, community cohort (n = 913)	Subjects with HTN (n = 664); 25.7% with OSA (untreated in the vast majority), 14% with RHTN; majority female.	Association between OSA and RHTN in blacks.	Subjects with moderate–severe OSA had a two-fold higher odds of RHTN (OR 2.0; 95% CI: 1.14–3.67) after accounting for confounders. OSA and oxyhemoglobin saturation <90% were not associated with uncontrolled BP.
Martinez-Garcia et al.⁶⁹⁶	2018	3b	Cross-sectional study (n = 229)	Consecutive subjects with RHTN, 18% met criteria for refractory HTN.	Association between refractory HTN and presence/severity of OSA.	Subjects with refractory HTN had a two-fold higher risk of OSA (prevalence of moderate OSA was 95% and severe OSA was 64%) and greater OSA severity (AHI 41.8 vs. 33.8; p = 0.026) compared to those with RHTN.
Sapina-Beltran et al.⁷⁰⁰	2019	3b	Multicenter cohort study (n = 284)	Consecutive subjects with RHTN.	Prevalence of OSA in subjects with RHTN and association of OSA with BP control.	83.5% had OSA, 25.7% moderate, and 26.1% severe OSA. Those with severe OSA had higher BP than those with mild/no OSA, with a greater effect noted on nighttime BP vs. those with no OSA. The prevalence of severe OSA was higher in those with uncontrolled BP (not statistically significant).

Abbreviations: AHI, apnea hypopnea index, events/hour; BP, blood pressure; CI, confidence intervals; DBP, diastolic blood pressure; OSA, obstructive sleep apnea; PAC, plasma aldosterone concentration; PSG, polysomnography; RCT, randomized controlled trial; RHTN, resistant hypertension; SBP, systolic blood pressure.