Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study.

Continuous Positive Airway Pressure Humans Hypertension / epidemiology Prospective Studies Sleep Apnea Syndromes Sleep Apnea, Obstructive / epidemiology
Accidente cerebrovascular Apnea del sueño CPAP Cardiovascular events Cerebrovascular disease Coronary heart disease Enfermedad cerebrovascular Enfermedad coronaria Eventos cardiovasculares Hipertensión resistente Presión positiva continua en las vías respiratorias Resistant hypertension Sleep apnea Stroke

Journal

Archivos de bronconeumologia
ISSN: 2173-5751
Titre abrégé: Arch Bronconeumol (Engl Ed)
Pays: Spain
ID NLM: 101777538

Informations de publication

Date de publication:
Mar 2021
Historique:
received: 09 09 2019
revised: 01 12 2019
accepted: 09 12 2019
pubmed: 8 2 2020
medline: 25 6 2021
entrez: 8 2 2020
Statut: ppublish

Résumé

There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3-6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP. Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96-2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07-15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2-11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05-1.02; p=0.053). In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.

Sections du résumé

BACKGROUND
There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE.
METHODS
Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3-6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP.
RESULTS
Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96-2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07-15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2-11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05-1.02; p=0.053).
CONCLUSIONS
In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.

Identifiants

DOI: 10.1016/j.arbres.2019.12.006 PMID: 32029279
pubmed: 32029279
pii: S0300-2896(19)30612-X
doi: 10.1016/j.arbres.2019.12.006
pii:
doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng spa

Sous-ensembles de citation

IM

Pagination

165-171

Informations de copyright

Copyright © 2021. Publicado por Elsevier España, S.L.U.

Auteurs

Cristina Navarro-Soriano (C)

Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Miguel-Angel Martínez-García (MA)

Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: mianmartinezgarcia@gmail.com.

Gerard Torres (G)

Internal Medicine Service, Hospital Universitari de Santa María, Lleida, Spain.

Ferrán Barbé (F)

Group of Traslational Research in Respiratory Medicine, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

Manuel Sánchez-de-la-Torre (M)

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.

Candela Caballero-Eraso (C)

Respiratory Department, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS), Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

Patricia Lloberes (P)

Respiratory Department, Hospital Universitario Vall Hebrón, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

Trinidad Díaz Cambriles (TD)

Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain.

María Somoza (M)

Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain.

Juan F Masa (JF)

Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

Mónica González (M)

Respiratory Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.

Eva Mañas (E)

Respiratory Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Mónica de la Peña (M)

Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.

Francisco García-Río (F)

Respiratory Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

Josep María Montserrat (JM)

Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

Alfonso Muriel (A)

Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain.

Grace Oscullo (G)

Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Alberto García-Ortega (A)

Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Tomás Posadas (T)

Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Francisco Campos-Rodríguez (F)

Respiratory Department, Hospital Universitario Valme, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation à pression positive › Ventilation en pression positive continue › Long-term Effect of CPAP Treatment on...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Long-term Effect of CPAP Treatment on...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › Long-term Effect of CPAP Treatment on...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Long-term Effect of CPAP Treatment on...
questionsmedicales.fr › Maladies du système nerveux › Syndromes d'apnées du sommeil › Long-term Effect of CPAP Treatment on...
questionsmedicales.fr › Maladies du système nerveux › Syndromes d'apnées du sommeil › Syndrome d'apnées obstructives du sommeil › Long-term Effect of CPAP Treatment on...