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Untreated severe obstructive sleep apnea associated with elevated BP
Patients with untreated severe obstructive sleep apnea appear to have higher levels of BP despite treatment with an intensive antihypertensive medication regimen, according to new data from the HeartBEAT study.
Researchers evaluated baseline data from HeartBEAT, a randomized controlled trial that assessed 284 patients with moderate to severe obstructive sleep apnea and high CV risk or established CVD collected from four outpatient cardiology clinics. The mean age of the cohort was 63 years and 23.6% had severe sleep apnea.
Patients were grouped according to BP level and use of an intensive antihypertensive medication regimen including three or more antihypertensive drugs and a diuretic. Controlled BP was defined as <130/80 mm Hg; uncontrolled elevated BP as ≥130/80 mm Hg without an intensive antihypertensive regimen; and resistant elevated BP as ≥130/80 mm Hg despite an intensive antihypertensive regimen.
As indicated by ambulatory monitoring, 61.6% of patients had controlled BP, 28.5% had uncontrolled elevated BP and 9.9% had resistant elevated BP. Patients who were prescribed an intensive antihypertensive regimen had a significantly increased risk for resistant elevated BP if they also had severe obstructive sleep apnea (58.3% vs. 28.6% with moderate sleep apnea; P=.01). This difference was not observed among patients who were not prescribed an intensive antihypertensive regimen.
After adjustment for confounders including age, sex, race, BMI, diabetes, CVD and smoking, patients with severe obstructive sleep apnea had a significantly increased risk for resistant elevated BP (OR=4.12; 95% CI, 1.67-10.2). Among 73 patients who received an intensive antihypertensive regimen, those with severe sleep apnea had a significantly increased risk for resistant elevated BP (adjusted OR=3.29; 95% CI, 1.01-10.74).
“Future investigations should focus on better understanding the mechanisms such as baroreflex, autonomic and aldosterone levels on BP control in [obstructive sleep apnea], the effect of BP variability and the responses to specific pharmacological and other interventions,” the researchers concluded. “Strategies to treat [obstructive sleep apnea] in this subgroup should be strongly considered, as improved control in BP could lead to decreased CV morbidity and mortality.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.