OSA linked with poor blood pressure control



BALTIMORE – Resistant hypertension was significantly more prevalent in adults with severe obstructive sleep apnea than in those with moderate OSA, despite the use of multiple antihypertensive medications, based on data from a randomized, controlled trial.

"Strategies to treat sleep apnea in this subgroup should be strongly considered, as improvements in blood pressure could potentially lead to improvements in cardiovascular morbidity and mortality," said Dr. Harneet Walia of the Cleveland Clinic, reporting results of her study at the annual meeting of the Associated Professional Sleep Societies.

Dr. Walia and her colleagues reviewed baseline data from 318 individuals at four sites participating in the HeartBEAT (Heart Biomarker Evaluation in Apnea Treatment) study. The trial randomized patients to receive an educational program about healthy lifestyle and sleep schedules, or the educational program plus either nighttime continuous positive airway pressure or nighttime supplemental oxygen. All patients underwent blood pressure monitoring and completed sleep studies with type III portable monitors.

Of the 318 participants, 73 were taking at least three prescribed antihypertensive medications, including a diuretic. Among these 73 patients, resistant hypertension was noted in 58% of those with severe obstructive sleep apnea and 28% of those with moderate OSA. The adjusted odds ratio for resistant blood pressure in severe OSA was 3.3.

Individuals with blood pressure greater than 170/110 mm Hg were excluded from the study, "so we may have underestimated the effects of sleep apnea," Dr. Walia said.

The average age of the patients was 65 years, approximately 70% were men, and the average apnea-hypopnea index (AHI) was 27. Resistant blood pressure was defined as failure to reach a target below 140/90 mmHg (or 130/80 mmHg for patients with diabetes or chronic kidney disease), despite the use of medication. Approximately half of patients with resistant hypertension met the criteria for severe OSA (AHI of 30 or higher).

"Rigorous trials are needed to assess the effects of sleep apnea treatment on blood pressure control in individuals on intensive antihypertensive regimens," Dr. Walia noted.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Walia said she had no relevant financial disclosures.

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