Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication

Sven Svedmyr; Jan Hedner; Sebastien Bailly; Francesco Fanfulla; Holger Hein; Carolina Lombardi; Ondrej Ludka; Stefan Mihaicuta; Gianfranco Parati; Athanasia Pataka; Sophia Schiza; Sezai Tasbakan; Dries Testelmans; Ding Zou; Ludger Grote; European Sleep Apnea Database (ESADA) study group

doi:10.1093/ehjopen/oead109

Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication

Eur Heart J Open. 2023 Oct 17;3(6):oead109. doi: 10.1093/ehjopen/oead109. eCollection 2023 Nov.

Authors

Sven Svedmyr^{1

2}, Jan Hedner^{1

2}, Sebastien Bailly³, Francesco Fanfulla⁴, Holger Hein⁵, Carolina Lombardi^{6

7}, Ondrej Ludka⁸, Stefan Mihaicuta⁹, Gianfranco Parati^{6

7}, Athanasia Pataka¹⁰, Sophia Schiza¹¹, Sezai Tasbakan¹², Dries Testelmans¹³, Ding Zou^{1

2}, Ludger Grote^{1

2}; European Sleep Apnea Database (ESADA) study group

Collaborators

European Sleep Apnea Database (ESADA) study group:
Steiropoulos P, Verbraecken J, Petiet E, Georgia Trakada, Fietze I, Penzel T, Ondrej Ludka, Bouloukaki I, Schiza S, McNicholas W T, Ryan S, Riha R L, Kvamme J A, Grote L, Hedner J, Zou D, Katrien Hertegonne, Dirk Pevernagie, Bailly S, Pépin J L, Tamisier R, Hein H, Basoglu O K, Tasbakan M S, Buskova J, Joppa P, Staats R, Dries Testelmans, Haralampos Gouveris, Ludwig K, Lombardi C, Parati G, Bonsignore M R, Francesco Fanfulla, Drummond M, van Zeller M, Randerath W, Marcel Treml, Dogas Z, Pecotic R, Pataka A, Anttalainen U, Saaresranta T, Sliwinski P

Affiliations

¹ Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden.
² Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden.
³ Université Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France.
⁴ Unità Operativa di Medicina del Sonno, Istituto Scientifico di Pavia IRCCS, Pavia, Italy.
⁵ Sleep Disorders Center, St.Adolf Stift, Reinbeck, Germany.
⁶ Cardiology Unit, Sleep Center, IRCCS Istituto Auxologico Italiano, Milan, Italy.
⁷ Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
⁸ Department of Internal Medicine, University Hospital Brno, Brno, Czech Republic.
⁹ Center for Research and Innovation in Precision Medicine and Pharmacy, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.
¹⁰ Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessalonikii, Thessalonikii, Greece.
¹¹ Sleep Disorders Unit, Department of Respiratory Medicine, School of Medicine, University of Crete, Crete, Greece.
¹² Department of Chest Diseases, Ege University, Izmir, Turkey.
¹³ Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium.

Abstract

Aims: We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT).

Methods and results: Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m², apnoea-hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin-angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders.

Conclusion: In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.

Keywords: Antihypertensive treatment; ESADA; Hypertension; Obstructive sleep apnoea; Precision medicine.