Given the limited data available in the literature, the aim of this study was to examine the risk of resistant hypertension (RHT) associated with restless legs syndrome (RLS) and periodic limb movements during sleep (PMLS) in a large sample of treated hypertensive individuals.

Demographic and polysomnographic data from 673 treated hypertensive individuals recruited from the research database of the sleep laboratory were analysed. After exclusion of the main causes of pseudo-resistance and secondary hypertension, RHT status was defined by the presence of an uncontrolled hypertension despite treatment with at least three antihypertensive agents (including a diuretic) from different classes in correct combination and at the highest tolerated doses or by the presence of controlled hypertension requiring the use of at least four antihypertensive agents. Logistic regression analyses were conducted to examine the risk of RHT associated with RLS and PMLS in treated hypertensive individuals.

After adjustment for major confounding factors associated with RHT, multivariate logistic regression analysis revealed that frequent RLS (≥2 episodes/week) combined to PLMS index ≥26/hour [OR 2.25 (95%CI1.37–3.69)] was significant risk factors of RHT in treated hypertensive individuals.

In treated hypertensive individuals, frequent RLS combined to PLMS index≥26/hour is associated with higher risk of RHT which suggests that this pathology may be a secondary cause of RHT (such as obstructive sleep apnea syndrome and insomnia with short sleep duration) justifying the establishment of effective treatment in order to avoid the negative consequences associated with the occurrence of resistance to antihypertensive agents.