Abstract

Aims

We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT).

Methods and results

Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, apnoea–hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by −3.9 ± 15.5/−2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by −3.0 ± 9.8/−2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin–angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders.

Conclusion

In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.

Details

Title
Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication
Author
Svedmyr, Sven 1   VIAFID ORCID Logo  ; Hedner, Jan 1   VIAFID ORCID Logo  ; Bailly, Sebastien 2 ; Fanfulla, Francesco 3 ; Hein, Holger 4 ; Lombardi, Carolina 5 ; Ludka, Ondrej 6 ; Mihaicuta, Stefan 7 ; Parati, Gianfranco 5   VIAFID ORCID Logo  ; Pataka, Athanasia 8   VIAFID ORCID Logo  ; Schiza, Sophia 9 ; Tasbakan, Sezai 10   VIAFID ORCID Logo  ; Testelmans, Dries 11   VIAFID ORCID Logo  ; Zou, Ding 1   VIAFID ORCID Logo  ; Grote, Ludger 1   VIAFID ORCID Logo  ; Steiropoulos, P; Verbraecken, J; Petiet, E; Trakada, Georgia; Fietze, I; Penzel, T; Bouloukaki, I; Schiza, S; McNicholas, W T; Ryan, S; Riha, R L; Kvamme, J A; Grote, L; Hedner, J; Zou, D; Hertegonne, Katrien; Pevernagie, Dirk; Bailly, S; Pépin, J L; Tamisier, R; Hein, H; Basoglu, O K; Tasbakan, M S; Buskova, J; Joppa, P; Staats, R; Gouveris, Haralampos; Ludwig, K; Lombardi, C; Parati, G; Bonsignore, M R; Drummond, M; van Zeller M; Randerath, W; Treml, Marcel; Dogas, Z; Pecotic, R; Pataka, A; Anttalainen, U; Saaresranta, T; Sliwinski, P

1  Department of Sleep Medicine, Sahlgrenska University Hospital , Blå stråket 5, 413 45 Gothenburg , Sweden 
2  Université Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital , Grenoble , France 
3  Unità Operativa di Medicina del Sonno, Istituto Scientifico di Pavia IRCCS , Pavia , Italy 
4  Sleep Disorders Center, St.Adolf Stift , Reinbeck , Germany 
5  Cardiology Unit, Sleep Center, IRCCS Istituto Auxologico Italiano , Milan , Italy 
6  Department of Internal Medicine, University Hospital Brno , Brno , Czech Republic 
7  Center for Research and Innovation in Precision Medicine and Pharmacy, ‘Victor Babes’ University of Medicine and Pharmacy , Timisoara , Romania 
8  Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessalonikii , Thessalonikii , Greece 
9  Sleep Disorders Unit, Department of Respiratory Medicine, School of Medicine, University of Crete , Crete , Greece 
10  Department of Chest Diseases, Ege University , Izmir , Turkey 
11  Sleep Disorders Centre, University Hospital Gasthuisberg , Leuven , Belgium 
Publication year
2023
Publication date
Nov 2023
Publisher
Oxford University Press
e-ISSN
27524191
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ehjopen/oead109
ProQuest document ID
3191803858
Copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.