Obstructive sleep apnea and nocturnal hypertension are associated with concentric geometry and systolic dysfunction in patients with resistant hypertension. RESIST POL study

Purpose: To evaluate the impact of night blood pressure (BP) and coexisting obstructive sleep apnea (OSA) and metabolic syndrome (MS) on left ventricle geometry and systolic function in patients with resistant hypertension (RHT). Methods: We analyzed data from 155 patients with true RHT (92M, 63F). All patients underwent thorough examination including: biochemical evaluations (MS was defined by The Adult Treatment Panel (ATP) III), ambulatory blood pressure monitoring (ABPM), polysomnography (OSA was defined as apnea/hypopnea index>15/h) and echocardiography. LVMI, relative wall thickness (RWT), LVEF, midwall fractional shortening (mwFS) and global longitudinal strain (GLS) were measured. Results: Patients were divided into 4 groups based on presence of MS and OSA: group 1) OSA(-), MS (-) [n=42], group 2) OSA(+), MS(-) [n=14], group 3) OSA (-), MS(+) [n=46] and group 4) OSA(+), MS(+) [n=53]. There were no differences in 24h BP values between these groups. In group 3 and 4 concentric geometry was present in 48,9 and 60,4% respectively. There were no differences in LVEF between groups. Group 3 and 4 characterized by lower mwFS as compared with 1 group (16,40±1,9 and 15,38±2,2 vs 17,44±1,9; p<0,049 and p<0,0001 respectively). Group 4 had significantly lower GLS as compared with 1 group (-12,64±3,3 vs -15,59±4,0; p<0,001). On a multivariate logistic regression model factors independently associated with concentric geometry were age, night systolic BP values (OR-1,56, 95%Cl; 1,23-1,97, p<0,0001) and OSA (OR-4,03, 95%Cl; 1,82-8,94, p=0,001). In a multivariate linear regression model factor independently associated with GLS was OSA (beta=0,279,p=0,001) whereas factors independently associated with mwFS were age, gender, nocturnal systolic BP, concentric geometry and metabolic syndrome. Conclusions: In patients with true RHT obstructive sleep apnea and nocturnal hypertension are associated with high prevalence of concentric geometry and cause subclinical systolic dysfunction as assessed by GLS and mwFS.