Obstructive sleep apnoea and hypertension: current understanding, diagnosis and management
Afzal, Medhia Livesey, Alana Hameed, Mohammed Awais Mukherjee, Rahul
Afzal, Medhia
Livesey, Alana
Hameed, Mohammed Awais
Mukherjee, Rahul
Abstract
Obstructive sleep apnoea (OSA) is a common, underdiagnosed disorder characterised by upper airway collapse, intermittent hypoxia and sympathetic activation. Hypertension frequently co-exists with OSA, with evidence supporting OSA-driven hypertension mediated by sympathetic overactivity, RAAS activation, and endothelial dysfunction. OSA-related hypertension often manifests as nocturnal hypertension and is linked to adverse cardiovascular outcomes. Prevalence is high in resistant hypertension, supporting targeted screening. Diagnosis should be considered in patients with daytime somnolence or refractory hypertension, using validated screening tools and sleep studies. Continuous positive airway pressure is the cornerstone of OSA management and can modestly lower blood pressure with cardiovascular benefit. Pharmacological management should follow hypertension guidelines, favouring agents that target relevant mechanisms (e.g. RAAS blockade and beta-blockade). Aldosterone antagonists are recommended in resistant hypertension. Emerging therapies, including endothelin receptor antagonists and GLP-1 receptor agonists, show promise but require further trials. This article reviews the epidemiology, mechanisms, diagnosis and management of OSA-related hypertension.
MIDER Authors
Afzal, Medhia
Livesey, Alana
Hameed, Awais
Makherjee, Rahul
Livesey, Alana
Hameed, Awais
Makherjee, Rahul
Affiliations
University Hospital Birmingham NHS Foundation Trust
Citations
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Date
2026-03-26
Type
Article
Subject
Collections
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Citation
Afzal M, Livesey A, Hameed MA, Mukherjee R. Obstructive Sleep Apnoea and Hypertension: Current Understanding, Diagnosis and Management. Clin Med (Lond). 2026 Mar 26:100575. doi: 10.1016/j.clinme.2026.100575. Epub ahead of print.