Refractory Hypertension And Sleep Apnea

Living With and Managing Sleep Apnea

JIM: I had this problem throughout my life. Driving was always a problem, and I tried to make sure that no place I ever had to go was very far away because I knew I'd fall asleep. Carol Lynn was complaining about snoring and, more specifically, snoring and then long periods of nothing,

and then a gasp when I would, you know, start breathing again. Obviously, I wanted to enjoy my life with my children more than I felt that I was enjoying it. It's Saturday morning, and the kids are at your bed ready to do something, and I'm just like, quot;I gotta sleep, guys. I'm sorry. I can't play with you. I can't do this.quot; And I look back and I'm like, quot;This just can't be right.quot;

I had been talking to my about possibly having depression symptoms. I remember the other thing that I said to the when I went was that I no longer had any dreams. If you're not getting into REM sleep, you have no dreams. And so she's the one who then said, quot;Okay, we're gonna send you for a sleep study.quot; I spent the night there.

The amount of times that I was technically waking, and as low as my blood oxygen levels were, it was extreme. I was diagnosed with severe obstructive sleep apnea. Surgery, as it turned out, really wasn't a good option for me. The next step was that my did prescribe a CPAP machine. CPAP stands for continuous positive airway pressure.

The idea is they have to get the air pressure to your nose or your mouth or both in order to keep your airway open while you sleep. Because it wasn't comfortable for me to use, I was not using it as well as I should have been, in some cases not at all for weeks at a time. And things got worse, other symptoms appeared. I felt confused and out of it and just not right.

And I realized that I really needed to figure out a way to learn to live with this contraption. Now I'm at the point where I am consistently using it and have been for a long period of time. I definitely feel better. I'm looking forward to feeling better yet. Certainly, I have more energy to do activities with the children than I did before, and we do more.

Sleep Apnea Sleep Deprivation and Obesity

Hi I'm Ananth Karumanchi, a nephrologist at Beth Israel Deaconess Medical Center and a professor of medicineat Harvard Medical School. I'm Virend Somers a cardiologistand professor of medicine at Mayo in Rochester. Somers, why should the hypertension community care about sleepé So, sleep and blood pressure

are very closely linked. Basically, in a physiologic sense, when people fall asleepthe blood pressure falls. What we know is if yourblood pressure doesn't fall at night when you're sleeping you fall into the nondipper category and that puts you at an increased risk of cardiovascular imports.

We also know that if youhave problems during sleep, if you develop obstructive sleep apnea, it will raise your blood pressure at night and raise your blood pressureeven during the day time. And the third compelling reason to care is that people who are sleep deprived don't get enough sleep at night, whether it's by choice

or whether it's by some external course, these people chronically will tend to have higher blood pressures than those who sleep normally. So, in your opinion, do all patients with hypertension would you recommend them to get a screen for some sort of sleep abnormalities.

No, no I wouldn't becausethe number of people with hypertension is so huge that logistically andeconomically wouldn't be feasible to study all these people. So we need to be veryselective on who we study and some of the points tothink about who we study would be people who have witnesses apneas, meaning the wife or husband says

I see him or her stopbreathing during sleep. That's called a witnessed apnea and a great sign of obstructive apnea. The other is if you hypertensive and you have day time somnolence. If you fall asleep duringthe day time very easily, then you quite likely have sleep apnea. If you have significant obesity,

Resistant and Refractory Hypertension

Well my name is AnanthKarumanchi, and I'm a nephrologist at the Beth IsraelDeaconess Medical Center, and a Professor of Medicineat Harvard Medical School. And I'm David Calhoun,Professor of Medicine at the University of Alabama in Birmingham, and Medical Director of the hypertension program there in Birmingham. So, David, what isrefractory hypertension,

and why should s beaware of this conditioné Well, we're proposinga refractory hypertension as sort of a new phenotypeof antihypertensive failure, so, historically resistant hypertension or difficult to treat hypertensionhas been defined as blood pressure's uncontrolledon three or more medicines, and we've recognized an evenmore severe group of patients who really, we can nevercontrol their blood pressure

in spite of maximumtherapy, so that may be five, six, or even seven medications. So, that's the groupthat we're referring to as refractory hypertension or a phenotype of antihypertensive failure. It's uncommon, even in our , probably only five percentof patients referred to us, but they are a verystriking group in terms of

how sever their hypertension is and the rate of complicationsin that group of patients. Is this condition increasingé Well, the major risk factors for having resistant hypertension,or I should say the strongest risk factors, are probably CKD, having CKD andbeing AfricanAmerican. But, in terms of resistant hypertension,

probably two of the mostcommon risk factors are obesity and older age, andbecause as a population, really worldwide, we'regetting older and heavier. And so I think that's thereason that the prevalence of resistant hypertensionis likely increasing. And finally, David, how do you manage these patients in your practiceé Our standard approach, if you will,

I mean obviously you have toindividualize per patient, but our standard approach is to, our first two medicationswe like to use are firstly a RASblocker, so eitheran ACE inhibitor or an ARB. We add to that a calcium channel blocker, which is in our most often Amlodipine because it's an effective,onceaday medication. As a third drug, we willadd, we use, Thiazide

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