SEVERITY OF SLEEP APNEA IMPACTS RISK OF RESISTANT HIGH BLOOD PRESSURE
A new study shows a
strong association between severe, untreated obstructive sleep apnea and the
risk of elevated blood pressure despite the use of high blood pressure
medications.
The study involved
patients who had cardiovascular risk factors or established heart disease and
moderate or severe obstructive sleep apnea. Among participants prescribed at
least three antihypertensives including a diuretic, resistant elevated blood
pressure was more prevalent in those with severe sleep apnea (58.3 %) compared
with moderate sleep apnea (28.6%). Further analysis found that the odds of
resistant elevated blood pressure were four times higher in participants with
severe, untreated obstructive sleep apnea even after adjusting for potential
confounders such as body mass index, smoking status, diabetes mellitus, and
cardiovascular disease (adjusted odds ratio = 4.12).
"Our findings
suggest that severe obstructive sleep apnea contributes to poor blood pressure
control despite aggressive medication use," said first author Dr. Harneet
Walia, assistant professor at the Cleveland Clinic Lerner College of Medicine
of Case Western Reserve University. "This is an important finding from a
clinical perspective as poor blood pressure control in patients taking multiple
antihypertensive medications makes them particularly vulnerable to increased
cardiovascular risk."
Study results are
published in the Aug. 15 issue of the Journal of Clinical Sleep
Medicine, which is published by the American Academy of Sleep Medicine.
"High blood
pressure that is resistant to treatment with medications is a strong warning
sign for the presence of obstructive sleep apnea, a chronic disease that
increases the risk for heart disease and stroke," said American Academy of
Sleep Medicine President Dr. Timothy Morgenthaler. "Over one-third of
patients with hypertension and nearly eight out of 10 patients with treatment
resistant hypertension have obstructive sleep apnea. People who have high blood
pressure should talk to a doctor about their risk for sleep apnea."
Data were analyzed
from the baseline examination of the Heart Biomarker Evaluation in Apnea
Treatment (HeartBEAT) study, a four-site randomized controlled trial comprising
patients with moderate to severe OSA who were under cardiovascular disease
management. The analysis involved 284 participants, of which 73 were prescribed
an intensive antihypertensive regimen.
"Even under the
close care of a cardiologist following national guidelines for treatment of
cardiovascular risk and comprehensive medication regimens, severe levels of
obstructive sleep apnea versus a moderate level of OSA appear to be
contributing to suboptimal blood pressure control," said Walia.
According to the
Centers for Disease Control and Prevention, about 36 million American adults
with high blood pressure don't have it under control. The American Academy of
Sleep Medicine reports that approximately 80 percent of people with
drug-resistant high blood pressure have obstructive sleep apnea, which involves
repetitive episodes of complete or partial upper airway obstruction occurring
during sleep despite an ongoing effort to breathe.
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