The HIPARCO-2 study: long-term effect of continuous positive airway pressure on blood pressure in patients with resistant hypertension: a multicenter prospective study.
Journal
Journal of hypertension
ISSN: 1473-5598
Titre abrégé: J Hypertens
Pays: Netherlands
ID NLM: 8306882
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
27
11
2020
medline:
16
10
2021
entrez:
26
11
2020
Statut:
ppublish
Résumé
Short-term treatment with continuous positive airway pressure (CPAP) produces a clinically significant reduction in blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension. However, it is unknown whether this effect continues over the long-term. Our objective was to assess the effect of long-term CPAP on BP in patients with OSA and resistant hypertension. The study included 161 patients diagnosed with both OSA [apnea--hypopnea index (AHI) ≥15] and resistant hypertension diagnosed via 24-hour ambulatory BP measurement (24-h ABPM), in whom a second analysis via 24-h ABPM was performed at the end of the follow-up. Patients were followed up within 59 months [interquartile range (IQR): 44-70]. CPAP treatment was prescribed to 82% of the patients (70% with good adherence to CPAP defined as use of CPAP at least 4 h/night). A comparison between the adherent group and nonadherent group (including those with CPAP not prescribed) showed that CPAP adherents had a significant drop in the 24-h BP, both systolic [-3.9 mmHg; 95% confidence interval (CI): -8.1 to 0.3] and diastolic pressure (-3.5 mmHg [95% [CI]: -6.4-0.5]), with a higher magnitude during the night (-5.5 and -4.9 mmHg, respectively). The CPAP adherent group needed a mean of 1.1 less antihypertensive drugs (particularly spironolactone). Finally, there was a positive correlation between the drop in 24-h SBP and the hours of CPAP use (r = 0.24; P = 0.01). Good adherence to long-term CPAP treatment largely succeeded in significantly reducing BP in those patients with OSA and resistant hypertension, despite the use of a lower number of antihypertensive drugs.
Identifiants
pubmed: 33239552
pii: 00004872-202102000-00016
doi: 10.1097/HJH.0000000000002664
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
302-309Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018 Jun;71(6):e136-e139] [published correction appears in Hypertension. 2018 Sep;72(3):e33]. Hypertension 2018; 71:1269–1324.
Persell SD. Prevalence of resistant hypertension in the United States, 2003–2008. Hypertension 2011; 57:1076–1080.
Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC, Crowley K, et al. REACH Registry Investigators. Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J 2013; 34:1204–1214.
Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM, et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005; 18:1422–1428.
Salles GF, Cardoso CRME, Muxfeldt ES. Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med 2016; 168:2340–2346.
Tsioufis C, Kasaiakogias A, Kordalis A, Dimitriadis K, Thomopoulos C, Tsiachris D, et al. Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study. J Hypertens 2014; 32:415–422.
Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012; 125:1635–1642.
Sánchez-de-la-Torre M, Campos-Rodriguez F, Barbé F. Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med 2013; 1:61–72.
Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep apnea. Types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol 2017; 69:841–858.
Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19:2271–2277.
Muxfeldt ES, Margallo VS, Guimarães GM, Salles GF. Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension. Am J Hypertens 2014; 27:1069–1078.
Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD, Somers VK, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers 2015; 1:15015.
Oscullo G, Torres G, Campos-Rodriguez F, Posadas T, Reina-González A, Sapiña-Beltrán E, et al. Resistant/refractory hypertension and sleep apnoea: current knowledge and future challenges. J Clin Med 2019; 8:1872.
Navarro-Soriano C, Martínez-García MA, Torres G, Barbé F, Caballero-Eraso C, Lloberes P, et al. on behalf the Spanish Sleep Network. Effect of continuous positive airway pressure in patients with true refractory hypertension and sleep apnea: a post-hoc intention-to-treat analysis of the HIPARCO randomized clinical trial. J Hypertens 2019; 37:1269–1275.
Martínez-García MA, Capote F, Campos-Rodríguez F, Lloberes P, Díaz de Atauri J, Somoza M, et al. Spanish Sleep Network. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 2013; 310:2407–2415.
Haynes RB, Sackett DL, Gibson ES, Taylor DW, Hackett BC, Roberts RS, Johnson AL. Improvement of medication compliance in uncontrolled hypertension. Lancet 1976; 1:1265–1268.
Liu L, Cao Q, Guo Z, Dai Q. Continuous positive airway pressure in patients with obstructive sleep apnea and resistant hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich) 2016; 18:153–158.
Navarro-Soriano C, Martínez-García MA, Torres G, Barbé F, Sánchez-de-la-Torre M, Caballero-Eraso C, et al. on behalf the Spanish Sleep Network. Long-term effect of CPAP treatment on cardiovascular events in patients with resistant hypertension and sleep apnea. Data from the HIPARCO-2 study. Arch Bronconeumol 2020; 3: pii: S0300-2896(19)30612-X. doi: 10.1016/j.arbres.2019.12.006.
doi: 10.1016/j.arbres.2019.12.006
pii: s0300-2896(19)30612-x.
Staessen JA, Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA 1999; 282:539–546.
Bloomfield D, Park A. Night time blood pressure dip. World J Cardiol 2015; 7:373–376.
Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 2005; 46:156–161.
Cardoso CR, Salles GF. Prognostic Importance of ambulatory blood pressure monitoring in resistant hypertension: is it all that matters? Curr Hypertens Rep 2016; 18 (12):85.
Sánchez-de-la-Torre M, Sánchez-de-la-Torre A, Bertran S, Abad J, Duran-Cantolla J, Cabriada V, et al. Spanish Sleep Network. Effect of obstructive sleep apnoea and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial. Lancet Respir Med 2019; 8:359–367.
McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al. SAVE Investigators and Coordinators. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 2016; 375:919–931.
Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, et al. Spanish Sleep and Breathing Group. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 2010; 181:718–726.
Williams B, Macdonald TM, Morant S, Webb DJ, Sever P, McInnes G, et al. British Hypertension Society's PATHWAY Studies Group. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet 2015; 386:2059–2068.
Václavík J, Sedlák R, Plachy M, Navrátil K, Plásek J, Jarkovsky J, et al. Addition of spironolactone in patients with resistant arterial hypertension (ASPIRANT): a randomized, double-blind, placebo-controlled trial. Hypertension 2011; 57:1069–1075.
Engbaek M, Hjerrild M, Hallas J, Jacobsen IA. The effect of low-dose spironolactone on resistant hypertension. J Am Soc Hypertens 2010; 4:290–294.
Gaddam K, Pimenta E, Thomas SJ, Cofield SS, Oparil S, Harding SM, Calhoun DA. Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J Hum Hypertens 2010; 24:532–537.
Yang L, Zhang H, Cai M, Zou AND, Jiang X, Song L, et al. Effect of spironolactone on patients with resistant hypertension and obstructive sleep apnea. Clin Exp Hypertens 2016; 38:464–468.
Banegas JR, Segura J, Sobrino J, Rodriguez-Artalejo F, de la Sierra A, De la Cruz JJ, et al. Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators. Effectiveness of blood pressure control outside the medical setting. Hypertension 2007; 49:62–68.
Sapiña-Beltrán E, Torres G, Martínez-Alonso M, Sánchez-de-la-Torre M, Franch M, Bravo C, et al. Rationale and Methodology of the SARAH Trial: long-term cardiovascular outcomes in patients with resistant hypertension and obstructive sleep apnea. Arch Bronconeumol 2018; 54:518–523.