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

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  1   2 , Jan Hedner  1   2 , Sebastien Bailly  3 , Francesco Fanfulla  4 , Holger Hein  5 , Carolina Lombardi  6   7 , Ondrej Ludka  8 , Stefan Mihaicuta  9 , Gianfranco Parati  6   7 , Athanasia Pataka  10 , Sophia Schiza  11 , Sezai Tasbakan  12 , Dries Testelmans  13 , Ding Zou  1   2 , Ludger Grote  1   2 ; European Sleep Apnea Database (ESADA) study group
Collaborators, Affiliations

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 et al. Eur Heart J Open. .

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.

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Conflict of interest statement

Conflict of interest: The ESADA study group received unrestricted funding grants from Respironics and Resmed Foundations (2008–11) and an unrestricted collaboration grant from Bayer AG (2018–22). S.S., corresponding author, reports no COI. He has grants from the Swedish Heart and Lung Foundation. J.H. reports no COI related to the content of the manuscript. He has institutional grants from Gothenburg University, Swedish Government Research and Educational grant LUA/ALF and grants from the Swedish Heart and Lung Foundation. Outside of the current manuscript, he has EU grants Horizon 2020, Eureka, and Inter Funding: Sleep Across Waters. He has consulting fees from SomnoMed (advisory input), has received research equipment from Itamar, and owns stock in Cereus Pharma. S.B. reports no COI. F.F. reports no COI. H.H. reports no COI. C.L. reports no COI. O.L. reports no COI. S.M. reports no COI. G.P. reports no COI; he has honoraria for lectures from Merck. A.P. reports no COI. S.S. reports no COI. S.T. reports no COI. D.T. reports no COI; he has payment to his Institution for lectures from Nyxoah. D.Z. reports no COI. L.G. reports no COI related to the content of the manuscript. He has institutional grants from LUA/ALF and the Swedish Heart and Lung Foundation. Outside the current manuscript, he provided lectures for Resmed, Philips, Astra Zeneca, and Lundbeck; and he has ownership in a patent licensed to Desitin GMBH related to sleep apnoea therapy.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
(A and B) Monotherapy, systolic blood pressure, and diastolic blood pressure control percentage before and after positive airway pressure treatment. ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker; BB, beta-blocker; BP, blood pressure; CAH, central acting antihypertensives; CCB, calcium channel blockers; DBP, diastolic BP; DIU, diuretics; PAP/CPAP, positive airway pressure; SBP, systolic BP.
Figure 2
Figure 2
(A and B) Dual therapy, systolic blood pressure, and diastolic blood pressure control before and after positive airway pressure treatment. ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker; BB, beta-blocker; BP, blood Pressure; CAH, central acting antihypertensives; CCB, calcium channel blockers; DBP, diastolic BP; DIU, diuretics; PAP/CPAP, positive airway pressure; SBP, systolic BP.
See this image and copyright information in PMC

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