Nasal obstruction tied to resistant hypertension in patients with uncontrolled hypertension and OSA

The findings imply that in addition to the OSA treatment, the evaluation and treatment of nasal obstruction should be considered in managing uncontrolled hypertensive patients with OSA.

Hao Wu from Capital Medical University in Beijing, China, and colleagues conducted the study to establish the independent predictive role of nasal obstruction in resistant hypertension among uncontrolled hypertensive patients with obstructive sleep apnea.

For this purpose, the researchers conducted a prospective cohort study of 236 OSA patients with uncontrolled BP using 1 or 2 antihypertensive drugs visiting the Sleep Medicine Center. Information was collected on various parameters, including BP control and classes of antihypertensive drugs, comorbidities, demographic characteristics, sleep parameters, Nasal Obstruction Symptom Evaluation (NOSE) Scale, and sleep-related symptoms. The incidence of resistant hypertension according to BP control and classes of antihypertensive medications data was collected during the 5-month follow-up.

The authors reported the following findings:

• After five month's follow-up, 217 participants were included in the final data analysis.
• Ninety-five patients had nocturnal nasal obstruction with a more significant proportion of RH (36.8% vs 17.2%) than those without nocturnal nasal obstruction.
• Following adjustments for OS severity, demographic characteristics and sleep-related symptoms, multinomial logistic regression models revealed that nocturnal nasal obstruction (all ORs > 2.5) or NOSE ≥ 8 (all ORs > 4.5) was independently associated with higher odds of RH.
• Nasal obstruction treatment improved the NOSE score significantly but did not considerably reduce RH incidence.
• Effective nasal obstruction treatment was linked with antihypertensive drug reduction (OR 4.43).

"In uncontrolled hypertensive patients with OSA, nasal obstruction seemed to be an independent predictor of resistant hypertension," the authors wrote."

"In addition to OSA treatment, assessment and treatment of nasal obstruction should be considered in managing uncontrolled hypertensive patients with OSA."

Reference:

Wu, H., Xie, J., Guo, Y. et al. The independent role of nasal obstruction in resistant hypertension for uncontrolled hypertensive patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol (2022). https://doi.org/10.1007/s00405-022-07772-2