The Seventh Joint N
ational Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) identified Sleep Apnea as a Cause of Hypertension way back in May of 2003. Thanks to Ed Grandi for sharing a the JNC7 Reference Card on LinkedIn that so clearly shows the recommended clinical approach to hypertension. Ed also shared his concern that the committee is considering removing sleep apnea as a cause of hypertension when they publish updates in JNC8.
What is not clear is whether they are considering moving sleep apnea to another category in the guidelines. I have not done a deep dive into the literature, by any means, but I have always gotten the sense that sleep apnea is more of a risk factor and/or a therapy because the data seems to show that 1) people who have sleep apnea tend to have higher rates of hypertension and 2) when someone with combined hypertension and sleep apnea is put on CPAP therap, their blood pressure tends to decline.
So, based on my experience, I wouldn’t be surprised if JNC8 moves Sleep Apnea into two different areas (where it belongs).
1) Risk Factor – OK, so apparently no one knows which came first, the Chicken or the Egg (does sleep apnea increase risk of hypertension or does hypertension increase the risk of sleep apnea?). But, clearly sleep apnea should be considered a risk factor for hypertension. Can you imagine a doctor not having a person with hypertension at least screened for sleep apnea?
2) Treatment Algorithm – Clearly, for at least a segment of the hypertensive population, a sleep apnea screening should be part of the algorithm. Can you imagine a hypertensive obese patient not getting screened for sleep apnea? Chances are very, very high that this type of patient has sleep apnea and that cpap therapy would reduce their blood pressure.
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