Cor Vasa 2015, 57(3):e157-e162 | DOI: 10.1016/j.crvasa.2015.03.011

Analysis of arterial hypertension pharmacotherapy in patients with obstructive sleep apnea syndrome

Milan Sova^a,*, Eliška Sovová^b, Milada Hobzová^a, Karel Urbánek^c, Jana Zapletalová^d, Monika Kamasová^b, Denisa Barinová^e, Barbora Gottfriedová^e, Irena Kuca^f, Vítězslav Kolek^a

^a Klinika plicních nemocí a tuberkulózy, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^b I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^c Ústav farmakologie, Lékařská fakulta Univerzity Palackého v Olomouci, Olomouc, Česká republika

^d Ústav lékařské biofyziky, Lékařská fakulta Univerzity Palackého v Olomouci, Olomouc, Česká republika

^e Lékařská fakulta Univerzity Palackého v Olomouci, Olomouc, Česká republika

^f Saba University School of Medicine, Saba, Dutch Caribbean, Nizozemsko

Introduction: Obstructive sleep apnea (OSA) is often connected with arterial hypertension and it could also be a cause of secondary hypertension. Treatment of arterial hypertension and optimal blood pressure level are important for prevention of cardiovascular complications. It is not well known how to treat patients with OSA and arterial hypertension. Also many patients with OSA suffer from metabolic syndrome which worsens their prognosis.

Aim: The aim of our study was to assess arterial hypertension compensation in patients with metabolic syndrome and moderate to severe OSA and to analyze used pharmacotherapy.

Materials and methods: 85 hypertensive patients (75 men) with metabolic syndrome, average age 53.6 ± 9.3 years, were evaluated using overnight sleep study with diagnosis of OSA, average apnea-hypopnea index (AHI) 56.3 ± 23. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and their current pharmacotherapy data were obtained. Appropriate combinations of antihypertensive drugs (patients with metabolic syndrome) were derived from ESH/ESC 2013 guidelines.

Results: Arterial hypertension was well compensated in only 11.8% of the patients. 24.7% patients were treated according to current guidelines. Fisher's exact test with analysis of adjusted residues has found higher rate of blood pressure subcompensation in patients treated with triple+ combination of drugs (p = 0.035, 51.4% vs 10%).

Conclusion: Only a small number of patients had optimal blood pressure level and were treated according to current ESH/ESC guidelines. We have to constantly appeal to all physicians to perform ABPM in patients with OSA.

Keywords: Ambulatory blood pressure monitoring; Masked hypertension; Nocturnal hypertension; Obstructive sleep apnea; Pharmacotherapy

Received: December 28, 2014; Revised: March 16, 2015; Accepted: March 19, 2015; Published: June 1, 2015  Show citation