Difficult to treat high blood pressure may be due to sleep apnea

The American Heart Association has issued consensus guidelines for treating resistant hypertension, a common, difficult-to-manage condition. Hypertension is called resistant if a patent's blood pressure remains elevated despite taking three medications to lower it, guideline chair David A. Calhoun, M.D., of the University of Alabama , and colleagues reported online in Hypertension. Resistance is also established if hypertension is controlled but it's taken four or more drugs to get there.

The committee's diagnostic advice:
1. Confirm treatment resistance. In addition to use of medications as noted above, office blood pressure, taken with good technique, should be greater than 140/90 or over 130/80 in patients with diabetes or chronic kidney disease;
2. Rule out the "white-coat effect" by use of ambulatory monitoring, if necessary;
3. Identify and reverse contributing lifestyle factors, such as obesity, physical inactivity, excessive alcohol ingestion, high salt and low-fiber diet;
4. Discontinue or minimize interfering substances, such as non-steroidal anti-inflammatory agents, diet pills, decongestants, stimulants, oral contraceptives, licorice, and ephedra;
5. Screen for secondary causes of resistant hypertension, such as obstructive sleep apnea, renal artery stenosis, primary aldosteronism, Cushing's syndrome, aortic co-arctation, and pheochromocytoma.

Our office treats many patients with obstructive sleep apnea. Typical symptoms include daytime sleepiness, falling asleep when you shouldn't, or a headache upon awakening in the morning. Patients with sleep apnea typically have snoring and sleeping partners may observe pauses in the breathing pattern. If any of these apply to you, then the only way to diagnose this condition with certainty is with a sleep study.