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Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature
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Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges

1
Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
2
Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, 25198 Lleida, Spain
3
Respiratory Department, Hospital Valme, 41014 Seville, Spain
4
Institute of Biomedicine of Seville (IBiS), 41013 Seville, Spain
5
Center of Biomedic Research in Respiratory Diseases (CIBERES), 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1872; https://doi.org/10.3390/jcm8111872
Received: 16 October 2019 / Revised: 28 October 2019 / Accepted: 1 November 2019 / Published: 5 November 2019
Hypertension is one of the most frequent cardiovascular risk factors. The population of hypertensive patients includes some phenotypes whose blood pressure levels are particularly difficult to control, thus putting them at greater cardiovascular risk. This is especially true of so-called resistant hypertension (RH) and refractory hypertension (RfH). Recent findings suggest that the former may be due to an alteration in the renin–angiotensin–aldosterone axis, while the latter seems to be more closely related to sympathetic hyper-activation. Both these pathophysiological mechanisms are also activated in patients with obstructive sleep apnoea (OSA). It is not surprising, therefore, that the prevalence of OSA in RH and RfH patients is very high (as reflected in several studies) and that treatment with continuous positive airway pressure (CPAP) manages to reduce blood pressure levels in a clinically significant way in both these groups of hypertensive patients. It is therefore necessary to incorporate into the multidimensional treatment of patients with RH and RfH (changes in lifestyle, control of obesity and drug treatment) a study of the possible existence of OSA, as this is a potentially treatable disease. There are many questions that remain to be answered, especially regarding the ideal combination of treatment in patients with RH/RfH and OSA (drugs, renal denervation, CPAP treatment) and patients’ varying response to CPAP treatment. View Full-Text
Keywords: Resistant hypertension; Refractory hypertension; Obstructive sleep apnoea; Continuous positive airway pressure Resistant hypertension; Refractory hypertension; Obstructive sleep apnoea; Continuous positive airway pressure
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Oscullo, G.; Torres, G.; Campos-Rodriguez, F.; Posadas, T.; Reina-González, A.; Sapiña-Beltrán, E.; Barbé, F.; Martinez-Garcia, M.A. Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges. J. Clin. Med. 2019, 8, 1872.

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