Correlation arterial stiffness and central blood pressure with obstructive sleep apnea in patients with resistant arterial hypertension

Abstract The aim assess correlation the arterial stiffness in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) Design 185 patients with AH were enrolled into the study. They were divided on 2 groups: OSA group – 148 patients were found to have OSA, indicated by at mean AHI of 38.1±2.5 h–1, and control group – 37 patients without OSA, mean AHI 3.02±0.25 h–1 (P<0.001). Patients of both groups were comparable on age, growth, total cholesterol level and office systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event/h) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event/h) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg/m2, P<0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg/dl, P<0,05), higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m/s, P<0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P<0,05). Patients of both groups had comparable office blood pressure (SBP 145.6±1.67 vs 138.4±3.66 mm Hg, P=0.057 and DBP 93.6+±1.18 vs 89.1±2.11 mm Hg, P=0.073), but significantly higher 24-h systolic and diastolic blood pressure. We suggest that in the study some patients with OSA had masked arterial hypertension. Daytime sleepiness in OSA patients was associated with structural remodeling of the left ventricle myocardium and more expressed arterial stiffness: ESS score was independently correlated with snoring duration (β=−0.008; P=0.021), interventricular septum thickness (β=0.023; P=0.026), LVMI (β=−0.037; P=0.039) and indexes of central pulse wave: ejection duration (ED) (β=−0.020; P<0.001) and subendocardial viability ratio (SEVR) (β=−0.224; P=0.012). Nocturnal hypoxemia in OSA patients was associated with increased aortic stiffness and higher central blood pressure: desaturation index was independently correlated with Aix (β=4.167; P=0.009), Aix75 (β=−3.929; P=0.006) and central DBP (β=0.151; P=0.004). Conclusion In patients with RH and OSA nocturnal hypoxemia correlation with increased aortic stiffness and higher central blood pressure. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract P255: Resistance Hypertension And Achievement Of Target Blood Pressure Level By Continuous Positive Airway Pressure Long Therapy In Patients With Obstructive Sleep Apnea

Hypertension ◽

10.1161/hyp.78.suppl_1.p255 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Oksana Rekovets ◽

Yuriy Sirenko ◽

Nina Krushynska ◽

Olena Torbas ◽

Svitlana Kushnir ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Arterial Hypertension ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

Resistant Arterial Hypertension

The aim was to assess the arterial stiffness changes in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy. Design: In 10 month follow-up study were included 46 patients with RAH, who were divided into groups: 1-st - patients with RAH and moderate to severe OSA on CPAP (n=21); 2-nd - patients with RAH and moderate to severe OSA without CPAP (n=25). They underwent somnography by dual-channel portable monitor device, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. All patients received similar antihypertensive therapy according to 2013 ESH Guidelines for the management of arterial hypertension. Results: Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event h-1) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event h-1) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg m-2, P<0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg dl-1, P<0,05)). Patients with RAH and OSA in comparison with patients with RAH without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m s-1, P<0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P<0,05). During 10 months follow-up in patients with RAH and moderate and sever OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.1±0.5 to 10.5±0.5 m s-1, P<0,05), decrease office systolic blood pressure (from 147.8±3.7 to 136.7±2.8 mm Hg; P<0,05) and diastolic blood pressure (from 96.8±3.5 to 87.0±3.3 mm Hg; P<0,05) with achievement of target levels in 67,2% patients. Central systolic BP decreased (from 143.8±2.7 to 137.7±2.8 mm Hg; P<0,05). Conclusion: The combination of therapy continuous positive airway pressure with antihypertensive treatment in patients with resistant arterial hypertension and moderate to severe obstructive sleep apnea improved achievement of target blood pressure, decreased arterial stiffness and decreased central blood pressure.

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Arterial stiffness and obstructive sleep apnea in patients with arterial hypertension and continuous positive airway pressure therapy

HYPERTENSION ◽

10.22141/2224-1485.14.2.2021.231855 ◽

2021 ◽

Vol 14 (2) ◽

pp. 39-49

Author(s):

Yu.M. Sirenko ◽

O.L. Rekovets ◽

N.A. Krushynska ◽

O.O. Torbas ◽

S.M. Kushnir ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Airway Pressure ◽

Pulse Wave ◽

Positive Airway Pressure ◽

Obstructive Sleep

Background. Obstructive sleep apnea (OSA), especially severe, is related to fatal and non-fatal cardiovascular events. OSA and arterial hypertension (AH) have significant correlations, and this comorbidity is very common and is associated with an increased risk of cardiovascular diseases. One of the causes is an increased arterial stiffness. Aortic pulse wave velocity is a highly reproducible noninvasive indicator of arterial stiffness recommended in current guidelines for evaluation of cardiovascular risk. The purpose of the study was to assess the arterial stiffness changes in patients with AH and OSA and possibilities of its correction by continuous positive airway pressure (CPAP) therapy. Materials and methods. One hundred and eighty-five patients with mild and moderate AH (49.80 ± ± 0.80 years old) were enrolled in the study and divided into groups: group 1 — those who had OSA (n = 148), group 2 — individuals without OSA (controls, n = 37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, evaluation of daytime sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and assessment of pulse wave velocity. The 10-month follow-up study included 105 patients, who were divided into 4 subgroups: A — those with moderate to severe OSA on CPAP (n = 23); B — individuals with moderate to severe OSA without CPAP (n = 29); C — patients with mild OSA (n = 29); D — people without OSA (controls, n = 24). All examinees received similar antihypertensive therapy according to 2013 European Society of Hypertension/European Society of Cardiology Guidelines. Results. Patients with AH and OSA (mean apnea-hypopnea index of 38.10 ± 2.51 events/h) compared to those without OSA (mean apnea-hypopnea index of 3.02 ± 0.25 events/h) had significantly higher body mass index (35.20 ± 0.57 kg/m2 vs 30.60 ± 0.79 kg/m2, P < 0.001), as well as blood glucose level (107.2 ± 2.2 mg/dl vs 98.0 ± 2.5 mg/dl, P = 0.045), uric acid level (6.17 ± 0.10 mg/dl vs 5.5 ± 0.3 mg/dl, P = 0.048) and left ventricular mass index (115.80 ± 2.39 g/m2 vs 104.60 ±± 4.56 g/m2, P = 0.035). During 10 months of follow-up, patients with AH and OSA on CPAP therapy reported a significant decrease in pulse wave velocity in elastic arteries (from 12.20 ± 0.63 m/s to 10.05 ± 0.43 m/s, P = 0.009), office systolic blood pressure (from 143.8 ± 132.7 mm Hg to 132.70 ± ± 2.33 mm Hg; P = 0.021) and diastolic blood pressure (from 93.80 ± 3.31 mm Hg to 86.00 ± 3.19 mm Hg; P = 0.012). Central systolic blood pressure also decreased (from 130.30 ± ± 3.97 mm Hg to 119.70 ± 2.97 mm Hg; P = 0.012). Conclusions. Combination of continuous positive airway pressure therapy and antihypertensive treatment improves arterial elasticity and helps achieve target blood pressure in hypertensive patients with moderate to severe obstructive sleep apnea.

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Diurnal and Obstructive Sleep Apnea Influences on Arterial Stiffness and Central Blood Pressure in Men

SLEEP ◽

10.1093/sleep/28.5.604 ◽

2005 ◽

Vol 28 (5) ◽

pp. 604-609 ◽

Cited By ~ 40

Author(s):

Craig Phillips ◽

Jan Hedner ◽

Norbert Berend ◽

Ronald Grunstein

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Stiffness ◽

Central Blood Pressure ◽

Obstructive Sleep

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Effect of eplerenone on the severity of obstructive sleep apnea and arterial stiffness in patients with resistant arterial hypertension

Polish Archives of Internal Medicine ◽

10.20452/pamw.3410 ◽

2016 ◽

Vol 126 (5) ◽

pp. 330-339 ◽

Cited By ~ 2

Author(s):

Beata Krasińska ◽

Angelika Miazga ◽

Szczepan Cofta ◽

Ludwina Szczepaniak-Chicheł ◽

Tomasz Trafas ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Stiffness ◽

Arterial Hypertension ◽

Obstructive Sleep ◽

Resistant Arterial Hypertension

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Ambulatory screening for obstructive sleep apnea in patients with resistant arterial hypertension

Sleep And Breathing ◽

10.1007/s11325-017-1583-5 ◽

2017 ◽

Vol 22 (2) ◽

pp. 361-367

Author(s):

Monika Kamasová ◽

Jan Václavík ◽

Tomáš Václavík ◽

Milada Hobzová ◽

Eva Kociánová ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Hypertension ◽

Obstructive Sleep ◽

Resistant Arterial Hypertension

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Abstract P216: Elevated Blood Glutathione Does Not Reduce Arterial Stiffness or Central Blood Pressure in Healthy Males and Females

Circulation ◽

10.1161/circ.137.suppl_1.p216 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Brianna K Bruggeman ◽

Katharine E Storo ◽

Haley M Fair ◽

Andrew J Wommack ◽

James M Smoliga ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Antioxidant Capacity ◽

Pulse Wave ◽

Central Blood Pressure ◽

Future Research ◽

Double Blind ◽

Mixed Effect ◽

Males And Females ◽

Healthy Males

Intro: Glutathione is endogenous within human plasma, erythrocyte lysate and is also bound to the protein within plasma. Glutathione mediates redox chemistry and prevents oxidative damage within and around cellular components via reduction of reactive species (e.g. reactive oxygen, nitrogen, or sulfur species). Polyphenols and antioxidants have been shown to improve NO bioavailability which may reduce long term incidence of endothelial dysfunction. Less is known about whether changes in antioxidant capacity augments the risk of developing hypertension. Hypothesis: We hypothesized that acute glutathione supplementation would decrease arterial stiffness and reduce both brachial (bBP) and central blood pressure (cBP) in healthy male and female volunteers. Methods: Six males and six females (25 ± 3 and 22 ± 1 years, respectively) participated in a randomized, double blind, placebo controlled, crossover protocol. On two visits separated by 1 week, following a 12-hour fast, participants consumed either a placebo or glutathione (negligible and 200 mg, respectively) supplement via 90 second sublingual absorption which was then swallowed. Concentrations of oxidized (GSSG) and reduced glutathione (GSH) were spectrophotometrically measured in plasma (protein-bound) and erythrocyte lysate using a kinetic, enzymatic assay. Arterial stiffness was measured via pulse wave velocity (PWV) using applanation tonometry, and cBP was determined non-invasively using pulse wave analysis. All data were recorded before supplementation (baseline) and at 10, 30, 60 and 120 minutes post-consumption. Results: Linear mixed effect models revealed a significant (p<0.01) increase in total glutathione (GSH+GSSG) in the supplement group compared to placebo across all post-supplementation time points with the greatest increase occurring at 120 minutes (mean 99.0; 95%CI: 7.9,190.1). At 120 minutes post-consumption, no difference was present between glutathione and placebo groups for PWV (5.86 ± 1.19 and 6.08 ± 1.25 m/s, respectively; p=0.43), resting heart rate (52.95 ± 3.55 and 55.83 ± 6.36, respectively; p=0.16), systolic bBP (123.05 ± 12.75 and 123.13 ± 14.52 mmHg; p=0.22), diastolic bBP (71.81 ± 7.87 and 74.21 ± 6.53; p=0.48), systolic cBP (108.05 ± 10.45 and 108.68 ± 11.14 mmHg, respectively; p=0.11) and diastolic cBP (72.03 ± 7.82 and 74.94 ± 6.42 mmHg, respectively; p=0.46). Conclusion: Young healthy males and females experienced an increase in circulating humoral antioxidants in response to glutathione supplementation. However, supplementation had minimal effects on resting hemodynamics. Future research should examine glutathione supplementation’s effect in participants with decreased antioxidant capacity and increased oxidative stress including patients with known disease such as hypertension or peripheral artery disease.

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