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Ou YH, Tan A, Lee CH. Management of hypertension in obstructive sleep apnea. Am J Prev Cardiol 2023; 13:100475. [PMID: 36873802 PMCID: PMC9976208 DOI: 10.1016/j.ajpc.2023.100475] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Obstructive sleep apnea (OSA) plays an important role in the development of hypertension. Thus, this review summarizes pharmacological and non-pharmacological approaches to blood pressure (BP) control in patients with OSA. Current treatments for OSA, such as continuous positive airway pressure, are effective at lowering BP. However, they only provide a modest BP reduction, and pharmacological treatment remains important for achieving optimal BP control. Furthermore, current guidelines for the treatment of hypertension do not make specific recommendations on pharmacological treatment protocols for controlling BP in patients with OSA. Moreover, the BP-lowering effects of various classes of antihypertensives may be different in hypertensive patients with OSA than in those without OSA due to the underlying mechanisms that promote hypertension in OSA. The acute and chronic increase in sympathetic nerve activity in patients with OSA explain the effectiveness of beta blockers in controlling BP in these patients. As activation of the renin-angiotensin-aldosterone system may also promote hypertension in OSA, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have generally been found effective for lowering BP in hypertensive patients with OSA. The aldosterone antagonist spironolactone also produces a good antihypertensive response in patients with OSA and resistant hypertension. However, there are limited data available that compare the effects of various classes of antihypertensive medication on BP control in those with OSA, and most data have been obtained from small-scale studies. This demonstrates the need for large-scale randomized controlled trials to evaluate a range of BP-lowering regimens in patients with OSA and hypertension.
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Affiliation(s)
- Yi-Hui Ou
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adeline Tan
- Department of Respiratory Medicine, Ng Teng Fong General Hospital, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
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Chen Q, Jiang D, Shan Z. Progression of Type B Intramural Hematoma Patients with Obstructive Sleep Apnea. J Vasc Surg 2022; 76:378-388.e3. [PMID: 35351604 DOI: 10.1016/j.jvs.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/11/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to estimate the influence of obstructive sleep apnea (OSA) on type B intramural hematoma (IMHB) progression. METHODS All 127 patients received sleep evaluations and esophageal pressure measurements. Variables associated with aorta-related adverse events and mortality were summarized by logistic regression analysis and Cox proportional hazard models. Competing risk analysis of death was used to estimate aorta-related and non-aorta-related mortality. RESULTS The OSA group had a higher aorta-related adverse events rate (46% vs. 4%, P<0.001). The mean nighttime systolic pressure (OR, 1.24; 95% CI, 1.11-1.38, P<0.001) was associated with aorta-related adverse events during the acute phase. Thoracic endovascular aortic repair (TEVAR) (HR, 16.2; 95% CI, 7.68-34.22, P<0.001) and mean morning systolic pressure (HR, 1.43; 95% CI, 1.22-1.68, P<0.001) were associated with a higher rate of occurrence of aorta-related adverse events. The occurrence of OSA (HR, 3.19; 95% CI, 2.57-12.15, P<0.001) and mean morning systolic pressure (HR, 1.59; 95% CI, 1.27-2.01, P=0.002) were significantly associated with aorta-related mortality. Competing risk analysis revealed significantly higher aorta-related mortality in the OSA group (11.8% vs. 2.0%, P=0.0412). A neutrophil-to-lymphocyte ratio (NLR) of > 3.52 (specificity: 90.2%, sensitivity: 89.5%) and a mean platelet volume-to-platelet ratio (MPV/PLT) of > 0.049 (specificity: 98.0%, sensitivity: 98.7%) have diagnostic value for detecting OSA in IMHB. CONCLUSIONS OSA leads to a higher aorta-related adverse event rate and mortality in patients with IMHB. Variables associated with outcomes include TEVAR, mean morning/nighttime systolic pressure and OSA. The NLR and MPV/PLT ratios are valuable for detecting OSA in IMHB patients.
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Affiliation(s)
- Qu Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Dandan Jiang
- Department of Respiratory Medicine, Xinglin Branch of The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Zhonggui Shan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, People's Republic of China.
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Hoshide S, Yoshida T, Mizuno H, Aoki H, Tomitani N, Kario K. Association of Night-to-Night Adherence of Continuous Positive Airway Pressure With Day-to-Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea. J Am Heart Assoc 2022; 11:e024865. [PMID: 35322679 PMCID: PMC9075445 DOI: 10.1161/jaha.121.024865] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The aim of this study was to investigate the association between night‐to‐night adherence to continuous positive airway pressure (CPAP) therapy and both home blood pressure (BP) level on the following day and seasonal variation in home BP in patients with obstructive sleep apnea. Methods and Results We analyzed 105 participants who had been diagnosed with obstructive sleep apnea (average apnea‐hypopnea index, 49.7±18.4 per hour) and who were already receiving CPAP therapy. Home BP (twice every morning and evening) and CPAP adherence data were automatically transmitted to a server for 1 year. A mixed‐effects model for repeated measures analysis was used to examine associations of night‐to‐night good CPAP adherence with day‐to‐day home BP within the same patient after adjusting for covariates. The average number of days in which patients achieved both CPAP adherence and morning or evening home BP measurement was 206.6±122.7 days (21 487 readings) and 191.2±126.3 days (20 170 readings), respectively. Good CPAP adherence (>4 hours per night of use) was achieved on the evening or morning before home BP measurements (86.8% and 86.9%, respectively). After adjustment for confounders, good CPAP adherence was negatively associated with morning home systolic BP (β, −0.663; P=0.004) and diastolic BP (β, −0.829; P<0.001). Morning home systolic BP in winter in the individuals with good CPAP adherence was significantly lower than that in individuals without such adherence (P<0.05). These associations were not found in evening home BP. Conclusions Good adherence to CPAP therapy was negatively associated with morning home BP on the following day in patients with obstructive sleep apnea. The association was remarkable in the winter season.
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Affiliation(s)
- Satoshi Hoshide
- Division of Cardiovascular Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Tetsuro Yoshida
- Department of Cardiovascular Medicine Onga Nakama Medical AssociationOnga Hospital Fukuoka Japan
| | - Hiroyuki Mizuno
- Division of Cardiovascular Medicine Jichi Medical University School of Medicine Tochigi Japan
| | | | - Naoko Tomitani
- Division of Cardiovascular Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine Jichi Medical University School of Medicine Tochigi Japan
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Labarca G, Schmidt A, Dreyse J, Jorquera J, Enos D, Torres G, Barbe F. Efficacy of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH): Systematic review and meta-analysis. Sleep Med Rev 2021; 58:101446. [PMID: 33607443 DOI: 10.1016/j.smrv.2021.101446] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022]
Abstract
Approximately 70-85% of patients with resistant hypertension (RH) report obstructive sleep apnea (OSA). However, whether therapy with continuous positive airway pressure (CPAP) improves blood pressure (BP) in this population is not clear. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy of CPAP in patients with OSA and RH. Two reviewers performed the literature search, risk of bias analysis, and data extraction. The pooled data were analyzed in a meta-analysis using the DerSimonian-Laird method. We calculated the mean difference (MD) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured at 24 h and in the daytime and nighttime. We also evaluated changes in aortic stiffness and aldosterone excretion. A total of 10 RCTs and 606 participants were included. CPAP was associated with changes in 24-h SBP (-5.06 mmHg; CI, -7.98, -2.13), 24-h DBP (-4.21 mmHg; CI, -6.5, -1.93), daytime SBP (-2.34 mmHg; CI, -6.94, +2.27), daytime DBP (-2.14 mmHg; CI, -4.96, -0.67), nighttime SBP (-4.15 mmHg; CI, -7.01, -1.29), and nighttime DBP (-1.95 mmHg; CI, -3.32, -0.57). We found no benefit for aortic stiffness, but it did lead to a mild reduction in aldosterone secretion. CPAP therapy improved BP, especially nighttime BP, in this population.
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Affiliation(s)
- Gonzalo Labarca
- Faculty of Medicine, University of Concepcion, Concepcion, Chile; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile.
| | - Alexia Schmidt
- Faculty of Medicine, University of Concepcion, Concepcion, Chile
| | - Jorge Dreyse
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS) Clínica Las Condes, Santiago, Chile
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS) Clínica Las Condes, Santiago, Chile
| | - Daniel Enos
- Faculty of Medicine, University of Concepcion, Concepcion, Chile; Nefrology, Complejo Asistencial Dr. Victor Rios Ruiz, Los Angeles, Chile
| | - Gerard Torres
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Ferran Barbe
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Wang Y, Li CX, Lin YN, Zhang LY, Li SQ, Zhang L, Yan YR, Lu FY, Li N, Li QY. The Role of Aldosterone in OSA and OSA-Related Hypertension. Front Endocrinol (Lausanne) 2021; 12:801689. [PMID: 35095768 PMCID: PMC8791261 DOI: 10.3389/fendo.2021.801689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 01/22/2023] Open
Abstract
Obstructive sleep apnea (OSA) is regarded as an independent risk factor for hypertension. The possible mechanism includes oxidative stress, endothelial injury, sympathetic excitement, renin-angiotensin-aldosterone system activation, etc. Clinical studies have found that there is a high coexistence of OSA and primary aldosteronism in patients with hypertension and that elevated aldosterone levels are independently associated with OSA severity in resistant hypertension. The underlying mechanism is that aldosterone excess can exacerbate OSA through increasing overnight fluid shift and affecting the mass and function of upper airway muscles during the sleep period. Thus, a bidirectional influence between OSA and aldosterone exists and contributes to hypertension in OSA patients, especially resistant hypertension.
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Affiliation(s)
- Yi Wang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Chuan Xiang Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Tongren Hospital Affiliated to Wuhan University, The Third Hospital of Wuhan, Wuhan, China
| | - Ying Ni Lin
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Li Yue Zhang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Shi Qi Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Liu Zhang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Ya Ru Yan
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Fang Ying Lu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Ning Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Qing Yun Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
- *Correspondence: Qing Yun Li,
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Zhang Y, Wu H, Xu Y, Qin H, Lan C, Wang W. The correlation between neck circumference and risk factors in patients with hypertension: What matters. Medicine (Baltimore) 2020; 99:e22998. [PMID: 33217801 PMCID: PMC7676568 DOI: 10.1097/md.0000000000022998] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is necessary to identify the relationship between neck circumference and cardiovascular risk factors in patients with hypertension.Patients with hypertension treated in our hospital were included. The height, weight, neck circumference, waist circumference, fasting blood glucose, 2 h blood glucose (2hPPG), density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1c) were analyzed and compared.A total of 2860 patients with hypertension were included. There were significant differences between male and female patients in the neck circumference, waist circumference, fasting blood glucose, Total cholesterol, triacylglycerol, HDL-C, LDL-C, diabetes, metabolic syndrome, dyslipidemia, drinking and smoking (all P < .05); the neck circumference was positively correlated with waist circumference, body mass index (BMI), fasting blood glucose, 2hPPG, HbA1c, triacylglycerol and LDL-C (all P < .05), and negatively correlated with HDL-C (P = .014); as the neck circumference increases, the risk of hypertension, diabetes, metabolic syndrome, abdominal obesity, and dyslipidemia increases accordingly (all P < .05); the area under curve (AUC) was 0.827 and 0.812, and the neck circumference of 37.8 and 33.9 cm was the best cut-off point for male and female patients, respectively.Neck circumference is closely related to cardiovascular risk factors in patients with hypertension, which should be promoted in the screening of cardiovascular diseases.
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