1009-166 Pulse pressure as cardiovascular risk marker during losartan or atenolol based therapy in hypertensive patients with electrocardiographic left ventricular hypertrophy (the LIFE trial) (original) (raw)
Related papers
Characteristics and Predictors of Obstructive Sleep Apnea in Patients With Systemic Hypertension
The American Journal of Cardiology, 2010
Obstructive sleep apnea (OSA) is a secondary cause of hypertension and independently associated with target-organ damage in hypertensive patients. However, OSA remains largely underdiagnosed and undertreated. The aim of the present study was to evaluate the characteristics and clinical predictors of OSA in a consecutive series of patients followed up in a hypertension unit. A total of 99 patients (age 46 ؎ 11 years, body mass index 28.8 kg/m 2 , range 25.1 to 32.9) underwent polysomnography. The clinical parameters included age, gender, obesity, daytime sleepiness, snoring, Berlin Questionnaire, resistant hypertension, and metabolic syndrome. Of the 99 patients, 55 (56%) had OSA (apnea-hypopnea index >5 events/hour). Patients with OSA were older and more obese, had greater levels of blood pressure, and presented with more diabetes, dyslipidemia, resistant hypertension, and metabolic syndrome than the patients without OSA. Of the patients with OSA, 51% had no excessive daytime sleepiness. The Berlin Questionnaire and patient age revealed a high sensitivity (0.93 and 0.91, respectively) but low specificity (0.59 and 0.48, respectively), and obesity and resistant hypertension revealed a low sensitivity (0.58 and 0.44, respectively) but high specificity (0.75 and 0.91, respectively) for OSA. Metabolic syndrome was associated with high sensitivity and specificity for OSA (0.86 and 0.85, respectively). Multiple regression analysis showed that age of 40 to 70 years (odds ratio 1.09, 95% confidence interval 1.03 to 1.16), a high risk of OSA on the Berlin Questionnaire (odds ratio 8.36, 95% confidence interval 1.67 to 41.85), and metabolic syndrome (odds ratio 19.04, 95% confidence interval 5.25 to 69.03) were independent variables associated with OSA. In conclusion, more important than the typical clinical features that characterize OSA, including snoring and excessive daytime sleepiness, the presence of the metabolic syndrome is as an important marker of OSA among patients with hypertension.
Romanian Journal of Rhinology, 2023
BACKGROUND. Sleep-breathing disorders are increasingly common in the general population, affecting the quality of life from many points of view. Patients with sleep-disordered breathing have a series of comorbidities, including arterial hypertension, which affects the quality of life also through the collateral manifestations of daytime sleepiness. MATERIAL AND METHODS. A descriptive study was conducted on a group of 134 patients who underwent investigations to determine the degree of obstructive sleep apnea syndrome (OSAS) by respiratory polygraphic and polysomnographic investigations. This group was also investigated from the point of view of blood pressure values as well as the degree of daytime sleepiness, an important element for the quality of life. RESULTS. The average age of the evaluated patients was 42.18±12.70 years, and the body mass index was 31.20±5.74 kg/m 2. The assessment of systemic blood pressure indicated an increased value above its standard normal value in most subjects: 58 patients (43.9%) were included in stage I hypertension, 9.8% in stage II, 1.5% of the subjects were diagnosed with stage III hypertension. To describe the relationship between OSAS and quality of life assessed by the degree of daytime sleepiness, we performed the regression and correlation analysis. The dependence between the values of the apnea-hypopnea index (AHI) and the ESS (the degree of daytime sleepiness) was positive; an increase in the AHI implies an increase in the ESS, thus a decrease in the quality of life. CONCLUSION. We can conclude that the severity of OSAS is directly involved in establishing the degree of arterial hypertension. Moreover, early detection is essential in order to decrease the degree of daytime sleepiness and implicitly increase the quality of life.
Assessing the Correlation between Severity of Obstructive Sleep Apnoea and Systemic Hypertension
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Obstructive sleep apnoea is present when repetitive episodes of cessation of breathing or decrement in airflow occurs during sleep, associated with sleep fragmentation, arousals from sleep and fall in oxygen saturation [1]. AHI (number of apnoea and hypopnoeas per hour of sleep) is used to define as well as classify the severity of sleep apnoea. OSA syndrome is defined by AHI equal to or greater than five events/ hour and persistent complains of excessive daytime somnolence or fatigue [1]. Obstructive apnoeas cause sympathetic surges conducive to development of acute cardiovascular events (i.e., stroke, myocardial infarction and nocturnal sudden death) and chronic conditions such as systemic hypertension, coronary artery disease and heart failure [2-4]. Various studies done abroad showed that about 50% of OSA patients are hypertensive and an estimated 30% of hypertensive patients also have OSA, often undiagnosed [5-9]. However, there is insufficient Indian data describing the effect of OSA on the severity of systolic and diastolic hypertension separately, independent of confounding factor of obesity in India. To fulfill this gap in knowledge, this study was carried out to determine the prevalence of hypertension associated with OSA, and to correlate the severity of hypertension with severity of OSA in terms of AHI Score.
Prediction of Systemic Hypertension in Patients with Sleep Apnea Syndrome
Experimental and clinical cardiology
Obstructive sleep apnea (OSA) is a prevalent condition and frequently associated with cardiovascular morbidity. Our aim was to identify best predictors for systemic hypertension (SH) in patients with OSA. We prospectively followed 589 consecutive patients with clinically OSA. The patients were included and followed-up for a mean period of 7 years. SH was found in 59.3% patients. The time from diagnostic to abnormal changes in blood pressure values was 7 ± 5 years. The hypertensive population was classified as follows: 10.9% with high normal values, 10.9% stage I, 28.9 % stage II, 8.6% stage III hypertension. Apnea-hypopnea index in all 3 levels, with reference normal, was extremely significant (p < 0.001) in hypertensive patients. Still, only severe OSA is the strongest predictor for hypertension, odds ratio 3.2 (p < 0.001, 95% CI 1.67 to 5.59). Mild and moderate OSA did not significantly influence the appearance of SH (p < 0.14, OR 0.58, 95% CI 0.29 to 1.20; p < 0.24, O...
Sleep Apnea Syndrome: APossible Contributing Factor to Resistant Hypertension.pdf
Study Objectives: There is evidence supporting an association between sleep apnea and hypertension. However, it is not clear if sleep apnea interferes with the pharmacotherapy of hypertension. To investigate this question, we studied the relationship between the effectiveness of antihypertensive treatment in reducing blood pressure, and severity of sleep apnea in a large group of apneic patients referred to a sleep disorders centre at St. Michael's Hospital at the University of Toronto. Design: N/A Setting: N/A Participants: 1485 adult patients with sleep apnea, as defined by the apnea/hypopnea index (AHI) >10 events/hr, were analyzed. There were 393 who reported using anti-hypertensive medications on a regular basis for more than 6 months. One hundred and eighty-three patients were treated "effectively" (i.e. blood pressure lower than 140/90 mm Hg in the morning and in the evening). Seventy-four patients were treated "ineffectively," defined as blood pressure >140/90 mm Hg in the morning or in the evening. Both groups were compared with respect to clinical and demographic data using analysis of covariance with gender, age, body mass index (BMI), and neck circumference (NC) as covariates.
Obstructive Sleep Apnea and Systemic Hypertension
American Journal of Respiratory and Critical Care Medicine, 2011
Rationale: Obstructive sleep apnea and systemic hypertension (SH) are highly prevalent. Although their association has been suggested in cross-sectional studies, conflicting evidence has emerged from longitudinal studies. Objectives: To assess the association between obstructive sleep apnea and SH in the middle-aged general population. Methods: A total of 2,148 subjects were included in a longitudinal study of the Vitoria Sleep Cohort, a general population sample aged 30-70 years. We analyzed data on office blood pressure, anthropometric measures, health history, and home polygraphy. Out of 1,557 subjects who completed the 7.5-year follow-up, 377 were excluded for having SH at baseline. The odds ratios for the incidence of SH, according to the respiratory disturbance index (RDI) at baseline, were estimated in 1,180 subjects (526 men and 654 women) after adjustment for age; sex; body mass index; neck circumference; fitness level; and alcohol, tobacco, and coffee consumption. The RDI was divided into quartiles (0-2.9, 3-6.9, 7-13.9, and > 14), using the first quartile as reference. Measurements and Main Results: The crude odds ratio for incident hypertension increased with higher RDI category with a doseresponse effect (P , 0.001), but was not statistically significant after adjustment for age (P ¼ 0.051). Adjustments for sex (P ¼ 0.342), body mass index (P ¼ 0.803), neck circumference (P ¼ 0.885), and fitness level and alcohol, tobacco, and coffee consumption (P ¼ 0.708) further reduced the strength of the association between RDI and SH. No differences were observed between men and women. Conclusions: Our findings do not suggest an association between obstructive sleep apnea and the incidence of SH in the middle-aged general population. Long-term follow-up longitudinal studies are needed to better ascertain this association.
2018
Background: Hypertension is identified as the third leading risk factor for morbidity and as the leading risk factor for mortality worldwide which is estimated to result in 7.5 million deaths annually. Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. Even though literature consistently relates presence of sleep apnea with hypertension, there is a dearth of data evaluating the relationship between duration of hypertension and presence of sleep apnea, both locally and internationally. Objectives: 1)To study the relationship between duration of hypertension and sleep apnea in hypertensive patients and 2) To assess the effect of age on such a relationship. Materials and Methods: A cross-sectional study was carried outon a total of 300 conveniently sampled patients, aged 18 or above, from the medical outpatient department of a secondary care hospital of Karachi after taking ethical approval. The inclusion criteria were self-reported hist...
Occult Nighttime Hypertension in Daytime Normotensive Older Patients With Obstructive Sleep Apnea
Journal of the American Medical Directors Association, 2012
Objectives: To assess nighttime blood pressure (BP), the dipping phenomenon and the relationships between nighttime BP, and polysomnography parameters in older patients with obstructive sleep apnea (OSA) who have been identified by their primary care physician as being normotensive during the daytime. Design: Cross-sectional study. Setting: University hospital-based geriatric sleep center. Participants: Daytime normotensive, community-dwelling older adults, consecutively referred by their primary care physicians for suspicion of OSA. Measurements: Overnight polysomnography and 24-hour ambulatory blood pressure measurement (ABPM). Daytime hypertension defined as systolic BP !135 mm Hg and/or diastolic BP !85 mm Hg. Nighttime hypertension defined as systolic BP !120 mm Hg and/or diastolic BP !70 mm Hg. Dipper pattern characterized by nighttime fall of mean BP !10%. Results: Forty-five participants (30 OSA; 15 non-OSA) completed the study (76.9 AE 6.2 years old). ABPM indicated clinically significant nighttime systolic (132.5 AE 16.0) and diastolic (72.6 AE 9.4) hypertension in patients with OSA previously classified as daytime normotensives and found only a mild degree of nighttime systolic hypertension (123.7 AE 16.1) in patients without OSA (P ¼ .105). A significant nondipping phenomenon was found in patients with OSA (e0.5 AE 7.4 vs 5.4 AE 6.4; P ¼ .016). Nighttime mean BP (r ¼ 0.301; P ¼ .049) and dipping status (r ¼ e0.478; P ¼ .001) were correlated with apnea-hypopnea index. A significant correlation was found between systolic BP (r ¼ 0.321; P ¼ .035), diastolic BP (r ¼ 0.373; P ¼ .013), mean BP (r ¼ 0.359; P ¼ .018), and hypoxia (sleep time spend with SaO2 <90%). Conclusion: Daytime normotensive older adults with OSA are at high risk for having occult nighttime hypertension. Thus, 24-hour ABPM may be appropriate for older patients with OSA whose clinical blood pressure does not display any daytime elevation.
Obstructive sleep apnoea and 24-h blood pressure in patients with resistant hypertension
Journal of Sleep Research, 2010
Obstructive sleep apnoea (OSA) is common in patients with resistant hypertension, but understanding of the pathogenic mechanisms linking both conditions is limited. This study assessed the prevalence of OSA and the relationships between OSA and 24-h blood pressure (BP) in 62 consecutive patients with resistant hypertension, defined as clinic BP values ‡ 140 ⁄ 90 despite the prescription of at least three drugs at adequate doses, including a diuretic. In order to exclude a Ôwhite coat effectÕ, only patients with ambulatory 24-h BP values ‡ 125 ⁄ 80 were recruited. Patients underwent polysomnography, 24-h ambulatory BP monitoring and completed the Epworth sleepiness scale (ESS). OSA was defined as an apnoea-hypopnoea index (AHI) ‡ 5 and excessive daytime sleepiness (EDS) by an ESS ‡ 10. A multiple linear regression analysis was used to assess the association of anthropometric data, OSA severity measures and ESS with 24-h systolic and diastolic BP. Mean 24-h BP values were 139.14 ⁄ 80.98 mmHg. Ninety per cent of patients had an AHI ‡ 5 and 70% had an AHI ‡ 30. Only the ESS was associated with 24-h diastolic BP [slope 0.775, 95% confidence interval (CI) 0.120-1.390, P < 0.02); age was associated negatively with 24-h diastolic BP (slope )0.64, 95% CI )0.874 to )0.411, P < 0.001). Compared with those without EDS, patients with EDS showed a significantly higher frequency of diastolic non-dipping pattern (69.2% versus 34.7%, P < 0.032). Our results demonstrate a high prevalence of severe OSA in patients with resistant hypertension and suggest that EDS could be a marker of a pathogenetic mechanism linking OSA and hypertension.