Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use

Harneet K. Walia, Hong Li, Michael Rueschman, Deepak L. Bhatt, Sanjay R. Patel, Stuart F Quan, Daniel J. Gottlieb, Naresh M. Punjabi, Susan Redline, Reena Mehra

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Rationale: We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defi ned as ≥ 3 antihypertensives including a diuretic. Defi nitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a finding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use.

Original languageEnglish (US)
Pages (from-to)835-843
Number of pages9
JournalJournal of Clinical Sleep Medicine
Volume10
Issue number8
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Obstructive Sleep Apnea
Antihypertensive Agents
Blood Pressure
Apnea
Cardiovascular Diseases
Cardiology
Diuretics
Body Mass Index

Keywords

  • Blood pressure
  • Cardiovascular disease
  • Sleep apnea

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use. / Walia, Harneet K.; Li, Hong; Rueschman, Michael; Bhatt, Deepak L.; Patel, Sanjay R.; Quan, Stuart F; Gottlieb, Daniel J.; Punjabi, Naresh M.; Redline, Susan; Mehra, Reena.

In: Journal of Clinical Sleep Medicine, Vol. 10, No. 8, 2014, p. 835-843.

Research output: Contribution to journalArticle

Walia, HK, Li, H, Rueschman, M, Bhatt, DL, Patel, SR, Quan, SF, Gottlieb, DJ, Punjabi, NM, Redline, S & Mehra, R 2014, 'Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use', Journal of Clinical Sleep Medicine, vol. 10, no. 8, pp. 835-843. https://doi.org/10.5664/jcsm.3946
Walia, Harneet K. ; Li, Hong ; Rueschman, Michael ; Bhatt, Deepak L. ; Patel, Sanjay R. ; Quan, Stuart F ; Gottlieb, Daniel J. ; Punjabi, Naresh M. ; Redline, Susan ; Mehra, Reena. / Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use. In: Journal of Clinical Sleep Medicine. 2014 ; Vol. 10, No. 8. pp. 835-843.
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abstract = "Rationale: We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defi ned as ≥ 3 antihypertensives including a diuretic. Defi nitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6{\%} with severe OSA), 61.6{\%} had controlled BP, 28.5{\%} had uncontrolled elevated BP, and 9.9{\%} had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3{\%} vs. 28.6{\%}, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95{\%} CI: 1.7-10.2), a finding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use.",
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AU - Walia, Harneet K.

AU - Li, Hong

AU - Rueschman, Michael

AU - Bhatt, Deepak L.

AU - Patel, Sanjay R.

AU - Quan, Stuart F

AU - Gottlieb, Daniel J.

AU - Punjabi, Naresh M.

AU - Redline, Susan

AU - Mehra, Reena

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N2 - Rationale: We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defi ned as ≥ 3 antihypertensives including a diuretic. Defi nitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a finding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use.

AB - Rationale: We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defi ned as ≥ 3 antihypertensives including a diuretic. Defi nitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ≥ 130/80 not on IAR) and resistant elevated BP (BP ≥ 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ≥ 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a finding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use.

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KW - Cardiovascular disease

KW - Sleep apnea

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