YOUNG HYPERTENSIVE PATIENTS WITH REVERSE DIPPING PHENOMENON UNMASKING UNDERLYING OBSTRUCTIVE SLEEP APNEA

Objective: To correlate the relationship with reverse dipping phenomena in hypertension and OSA Design and method: Case study of two young hypertensive patients who underwent 24 hours BP monitoring, Sphygmocor determination for arterial stiffness and sleep study. Correlation between CPAP use and BP control were determined after a year. Results: Case 1: 24 hours blood pressure (BP) showed reverse dipping pattern (-5.1%). Sphygmocor showed no increase in arterial stiffness as evidenced by normal aortic systolic blood pressure of 97 mmHg with aortic augmentation of 1 mmHg (At heart rate of 75). Sleep study confirmed moderate obstructive sleep apnea. Biochemical and other investigations unremarkable. Night continuous positive airway pressure (CPAP) was prescribed however, patient used intermittently. After a year of intermittent CPAP use, hypertension did not worsen and BP remained around 140/80 mmHg and she did not need any anti-hypertensive treatment. Case 2: 24 hours blood pressure (BP) showed reverse dipping pattern (-6.3%). Sleep study confirmed severe obstructive sleep apnoea. Biochemical and other investigations unremarkable. Night continuous positive airway pressure (CPAP) was prescribed however; patient was not compliant. After a 2 -year follow-up, she gained 4 kg of weight and she needed nifedipine 30 mg two times a day to control hypertension. Conclusions: Delay in the identification of hypertension with obstructive sleep apnea or failure of early successful treatment can potentially cause serious cardiovascular consequences especially among young hypertensive patients. These patients would benefit from 24 hours ABPM to see for non-dipping or reverse dipping phenomenon.