Current Knowledge/Study Rationale: Individuals with hypertension requiring multiple medications have a high cardiovascular risk, and they commonly have concomitant obstructive sleep apnea (OSA). Evidence supporting the association between OSA and myocardial damage in difficult-to-control hypertension is lacking.
Study Impact: This is the first study substantiating that low-grade myocardial injury is present in patients with OSA and difficult-to-control hypertension, irrespective of blood pressure control with medications. Frequent intermittent hypoxia, aging, and loss of nocturnal dip in systolic blood pressure were predictors of higher high-sensitivity troponin level. The current study affirms the high prevalence of severe OSA in difficult-to-control hypertension, and emphasizes that in addition to controlling blood pressure with medications, it is also necessary to target the control of OSA to mitigate cardiovascular risk.