Blood pressure control in hypertensive sleep apnea patients of the ESADA cohort-effects of PAP and antihypertensive medication

Abstract Introduction We analysed longitudinal blood pressure data from hypertensive Obstructive Sleep Apnea (OSA) patients from the European Sleep Apnea Database (ESADA) cohort. The study investigated the interaction between positive airway pressure (PAP) induced blood pressure (BP) change and antihypertensive treatment (AHT). Methods Hypertensive patients with AHT (monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 yrs, Body Mass Index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, Apnea Hypopnea Index (AHI) 46 ± 25/46 ± 24 n/h, proportion female 29%/26%, respectively) started PAP treatment. Office BP at baseline and follow up 2-36 months were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influence of age, gender, BMI, comorbidities, BP at baseline and study site were evaluated. Results Following PAP treatment (5.6 ± 1.6/5.7 ± 1.9 hrs/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 mono therapy group. Intake of Renin-Angiotensin-Blockers (ACEI/ARB) alone or in any AHT combination was associated with better BP control. AHT dependent BP improvement was independent of confounders. Conclusion In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Duration of PAP treatment 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.