Kaycee Otuonye MSN Dr Elizabeth Moxley Ph D

Kaycee Otuonye, MSN, Dr. Elizabeth Moxley, Ph. D, RN Outcomes of Resistant Hypertension in Patients on Treatment for Obstructive Sleep Apnea Conceptual Framework Introduction: Resistant hypertension (r. HPT) occurs in 15 to 20% of treated hypertensive patients. 70 to 80% of r. HPT patients have obstructive sleep apnea (OSA) and there is a linear relationship between the severity of r. HPT and the severity of OSA. Also r. HPT patients are 2. 5 times at risk for OSA than non-r. HPT patients. In a study by Dernaika et al. , 71% of patients with r. HPT decreased their antihypertensive treatment while on CPAP therapy but not the same with patients with controlled hypertension, endocrinological disorders e. g. primary Aldosteronism, kidney diseases, renal artery stenosis, hypervolemia, chronic stress, chronic pain and drugs e. g. NSAIDS Purpose: The purpose of this integrative literature review is to Results & Discussion: 12 studies were considered in this literature review. Key variables such as obesity, age, inadequate policy on screening for OSA in hypertensive patients, increasing cardiovascular co morbidities, poor medication compliance, effect of CPAP treatment on r. HPT patients, factors that worsened outcome of treatment and effects of secondary causes of r. HPT were analyzed using table matrix. Dietary salts and hyperaldosteronism were associated with the severity of r. HPT. Spironolactone, CPAP, antihypertensive and diuretics significantly reduced BP in r. HPT patients and improved cardiovascular status. Conclusion: Treating OSA with CPAP promoted examine the outcomes of OSA and r. HPT and to find out if control of OSA translate into improved cardiovascular status. It will guide in making a policy on the effective management of OSA in hypertensive patients significant BP reductions in patients with true r. HTN which significantly reduced cardiovascular complications. RHTN and OSA have common pathogenic associations and long -term adherence to CPAP therapy has been shown to suppress sympathetic activity and improve blood pressure in patients with r. HPT. Methods: Literature reviewed was from the following Nursing Implications: Nurses should encourage databases: CINAHL Complete (7 articles), Pubmed (5 articles) and Psycho. Info (1 article). Search terms included: Obstructive sleep apnea, resistant hypertension, continous positive airway pressure. screening of OSA as a modifiable risk factor in patients presenting for the management of r. HTN. Nurses should encourage early detection and treatment of OSA in vulnerable population and direct patient education towards encouraging medication adherence. References: Gonzaga, C. , Bertolami, A. , Bertolami, M. , Amodeo, C. , & Calhoun, D. (2015). Obstructive sleep apnea, hypertension and cardiovascular diseases. Journal of Human Hypertension, 29(12), 705– 12. http: //doi. org/10. 1038/jhh. 2015. 15 Maeder M. T. , Schoch R. H. (2016). A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease. Vascular Health and Risk Management, 12, 85– 103. http: //doi. org/10. 2147/VHRM. S 74703 Min, H. J. , Cho, Y. -J. , Kim, C. -H. , Kim, D. H. , Kim, H. Y. , Choi, J. I. , … Cho, H. -J. (2015). Clinical features of obstructive sleep apnea that determine its high prevalence in resistant hypertension. Yonsei Medical Journal, 56(5), 1258 – 1265. http: //doi. org/10. 3349/ymj. 2015. 56. 5. 1258