Specifics of daily blood pressure monitoring in patients with systemic hypertension and obstructive sleep apnoea: a case-control study

Background. The comorbidity of arterial hypertension (AH) and obstructive sleep apnea syndrome (OSA) is becoming increasingly common in clinical practice. However, the priority strategy for selecting antihypertensive therapy in such patients is yet to be defined. 24-hour blood pressure monitoring is important for determining an approach to controlling hypertension.
Objectives. To study specific features of 24-hour blood pressure monitoring in comorbid AH– OSA patients.
Methods. A total of 130 AH patients were surveyed. The main cohort (1) included AH–OSA patients (n = 90, mean age 54.93 ± 1.04 years), control cohort (2) — non-OSA AH patients (n = 40, mean age 57.92 ± 1.29 years). All patients had a general clinical examination with 24-hour blood pressure monitoring. OSA was verified in overnight respiratory polygraphy using an Alice PDx diagnostic appliance (USA).
Results. The following specific features of 24-hour blood pressure monitoring were identified in the comorbid patients: a statistically significant growth of mean 24-hour systolic and average BP, as well as mean nocturnal systolic, diastolic and average BP; a statistically significant growth of mean 24-hour systolic, diastolic and average BP load indices. In addition, the AH-OSA patients had the statistically higher pulse pressure, systolic and average BP variability, as well as morning BP surge rate. The 24-hour BP dynamics in OSA patients had predominant morbid profiles and higher non-dipper and night-peaker rates compared to the control cohort.
Conclusion. The identified specific features reflect a high risk of adverse cardiovascular events in AH–OSA comorbid patients, an earlier damage of target organs and negative prognosis of comorbidity, which warrants a further analysis of AH-specific clinical picture and personalisation of blood pressure control measures in such patients.

1. Chazova I.E., Zhernakova Yu.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16(1): 6–31 (In Russ.). DOI: 10.26442/2075082X.2019.1.190179

2. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., Clement D.L., Coca A., de Simone G., Dominiczak A., Kahan T., Mahfoud F., Redon J., Ruilope L., Zanchetti A., Kerins M., Kjeldsen S.E., Kreutz R., Laurent S., Lip G.Y.H., McManus R., Narkiewicz K., Ruschitzka F., Schmieder R.E., Shlyakhto E., Tsioufis C., Aboyans V., Desormais I.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart. J. 2018; 39(33): 3021–3104. DOI: 10.1093/eurheartj/ehy339

3. Vyalova M.O., Shvarts Yu.G. Arterial hypertension and cardiovascular risk score in people in their middle and late adulthood during sports and physical training. Cardiology: News, Opinions, Training. 2019; 7(2): 36– 44 (In Russ., English abstract). DOI: 10.24411/2309-1908-2019-12004

4. Kobalava Z.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., Barbarash O.L., Boitsov S.A., Vavilova T.V., Villevalde S.V., Galyavich A.S., Glezer M.G., Grineva E.N., Grinstein Yu.I., Drapkina O.M., Zhernakova Yu.V., Zvartau N.E., Kislyak O.A., Koziolova N.A., Kosmacheva E.D., Kotovskaya Yu.V., Libis R.A., Lopatin Yu.M., Nebiridze D.V., Nedoshivin A.O., Ostroumova O.D., Oschepkova E.V., Ratova L.G., Skibitsky V.V., Tkacheva O.N., Chazova I.E., Chesnikova A.I., Chumakova G.A., Shalnova S.A., Shestakova M.V., Yakushin S.S., Yanishevsky S.N. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020; 25(3): 3786 (In Russ.). DOI: 10.15829/1560-4071-2020-3-3786

5. Bazdyrev Y.D., Gerasimova Y.B., Polikutina O.M., Savelieva I.A., Smakotina S.A., Barbarash O.L. Cardiovascular risk factors in patients with chronic obstructive pulmonary disease. The Clinician. 2014; 8(1): 22–27 (In Russ., English abstract). DOI: 10.17650/1818-8338-2014-1-22-27

6. Samorodskaya I.V., Bazdyrev E.D., Barbarash O.L. Cardiovascular risk factor paradox. A focus on smoking. Complex Issues of Cardiovascular Diseases. 2019; 8(1): 90–99 (In Russ., English abstract). DOI: 10.17802/2306-1278-2019-8-1-90-99

7. Kostyuchenko G.I., Vyun O.G., Kostyuchenko L.A. The analysis of the efficiency of hypotensive therapy in the group of young patients on the background of genetic polymorphism associated with arterial hypertension. The Journal of scientific articles “Health and Education Millennium”. 2018; 20(2): 46– 49 (In Russ., English abstract). DOI: 10.26787/nydha-2226-7425-2018-20-2-46-49

8. Oganov R.G., Denisov I.N., Simanenkov V.I., Bakulin I.G., Bakulina N.V., Boldueva S.A., Barbarash O.N., Garganeeva N.P., Doshchitsin V.L., Drapkina O.M., Dudinskaya E.N., Kotovskaya Yu.V., Lila A.M., Mamedov M.N., Mardanov B.U., Miller O.N., Petrova M.M., Pozdnyakov Yu.M., Runikhina N.K., Sayganov S.A., Tarasov A.V., Tkacheva O.N., Urinsky A.M., Shalnova S.A. Comorbidities in practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017; 16(6): 5–56 (In Russ.) DOI: 10.15829/1728-8800-2017-6-5-56

9. Tarlovskaya E.I. Comorbidity and polymorbidity — a modern interpretation and urgent tasks facing the therapeutic community. Kardiologiia. 2018; 58(S9): 29–38 (In Russ., English abstract). DOI: 10.18087/cardio.2562

10. Konecny T., Kara T., Somers V.K. Obstructive sleep apnea and hypertension: an update. Hypertension. 2014; 63(2): 203–209. DOI: 10.1161/HYPERTENSIONAHA.113.00613

11. Boytsov S.A., Balanova Yu.A., Shalnova S.A., Deev A.D., Artamonova G.V., Gatagonova T.M., Duplyakov D.V., Efanov A.Yu., Zhernakova Yu.V., Konradi A.O., Libis R.A., Minakov A.V., Nedogoda S.V., Oshchepkova E.V., Romanchuk S.A., Rotar O.P., Trubacheva I.A., Chazova I.E., Shlyakhto E.V., Muromtseva G.A., Evstifeeva S.E., Kapustina A.V., Konstantinov V.V., Oganov R.G., Mamedov M.N., Baranova E.I., Nazarova O.A., Shutemova O.A., Furmenko G.I., Babenko N.I., Azarin O.G., Bondartsov L.V., Khvostikova A.E., Ledyaeva A.A., Chumachek E.V., Isaeva E.N., Basyrova I.R., Kondratenko V.Yu., Lopina E.A., Safonova D.V., Skripchenko A.E., Indukaeva E.V., Cherkass N.V., Maksimov S.A., Danilchenko Y.V., Mulerova T.A., Shalaev S.V., Medvedeva I.V., Shava V.G., Storozhok M.A., Tolparov G.V., Astakhova Z.T., Toguzova Z.A., Kaveshnikov V.S., Karpov R.S., Serebryakova V.N. Arterial hypertension among individuals of 25–64 years old: prevalence, awareness, treatment and control by the data from ECCD. Cardiovascular Therapy and Prevention. 2014; 13(4): 4–14 (In Russ., English abstract). DOI: 10.15829/1728-8800-2014-4-4-14

12. Khattak H.K., Hayat F., Pamboukian S.V., Hahn H.S., Schwartz B.P., Stein P.K. obstructive sleep apnea in heart failure: review of prevalence, treatment with continuous positive airway pressure, and prognosis. Tex. Heart. Inst. J. 2018; 45(3): 151–161. DOI: 10.14503/THIJ-15-5678

13. Heinzer R., Vat S., Marques-Vidal P., Marti-Soler H., Andries D., Tobback N., Mooser V., Preisig M., Malhotra A., Waeber G., Vollenweider P., Tafti M., Haba-Rubio J. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet. Respir. Med. 2015; 3(4): 310–318. DOI: 10.1016/S2213-2600(15)00043-0

14. Drager L.F., Genta P.R., Pedrosa R.P., Nerbass F.B., Gonzaga C.C., Krieger E.M., Lorenzi-Filho G. Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension. Am. J. Cardiol. 2010; 105(8): 1135–1139. DOI: 10.1016/j.amjcard.2009.12.017

15. Torres G., Sánchez-de-la-Torre M., Martínez-Alonso M., Gómez S., Sacristán O., Cabau J., Barbé F. Use of ambulatory blood pressure monitoring for the screening of obstructive sleep apnea. J. Clin. Hypertens. (Greenwich). 2015; 17(10): 802–809. DOI: 10.1111/jch.12619

16. Madaeva I.M., Berdina O.N., Semenova N.V., Kolesnikova L.I. Evaluation of the structural organization of sleep in obstructive apnea syndrome from the perspective of modern pathophysiology. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2020; 120(9): 80 (In Russ., English abstract). DOI: 10.17116/jnevro202012009280

17. Sateia M.J. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014; 146(5): 1387–1394. DOI: 10.1378/chest.14-0970

18. Ziegler M.G., Milic M., Sun P. Antihypertensive therapy for patients with obstructive sleep apnea. Curr. Opin. Nephrol. Hypertens. 2011; 20(1): 50–55. DOI: 10.1097/MNH.0b013e3283402eb5

19. Azarbarzin A., Ostrowski M., Moussavi Z., Hanly P., Younes M. Contribution of arousal from sleep to postevent tachycardia in patients with obstructive sleep apnea. Sleep. 2013; 36(6): 881–889. DOI: 10.5665/sleep.2716

20. Azarbarzin A., Sands S.A., Younes M., Taranto-Montemurro L., Sofer T., Vena D., Alex R.M., Kim S.W., Gottlieb D.J., White D.P., Redline S., Wellman A. The sleep apnea-specific pulse-rate response predicts cardiovascular morbidity and mortality. Am. J. Respir. Crit. Care. Med. 2021; 203(12): 1546–1555. DOI: 10.1164/rccm.202010-3900OC

21. de la Sierra A. Valor de la presión de pulso como marcador de riesgo cardiovascular [Value of pulse pressure as a cardiovascular risk marker]. Med Clin (Barc). 2006; 126(10): 384–388. Spanish. DOI: 10.1157/13086050

22. Domanski M., Mitchell G., Pfeffer M., Neaton J.D., Norman J., Svendsen K., Grimm R., Cohen J., Stamler J.; MRFIT Research Group. Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 2002; 287(20): 2677–2683. DOI: 10.1001/jama.287.20.2677

23. Franklin S.S., Lopez V.A., Wong N.D., Mitchell G.F., Larson M.G., Vasan R.S., Levy D. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation. 2009; 119(2): 243–250. DOI: 10.1161/CIRCULATIONAHA.108.797936

24. Lawes C.M., Bennett D.A., Feigin V.L., Rodgers A. Blood pressure and stroke: an overview of published reviews. Stroke. 2004; 35(3): 776–785. DOI: 10.1161/01.STR.0000116869.64771.5A

25. Gorbunova M.V., Babak S.L., Adasheva T.V., Malyavin A.G. Blood pressure and arterial stiffness dynamics depending on the duration of cpap night sessions in patients with severe obstructive sleep apnea. The Russian Archives of Internal Medicine. 2019; 9(4): 280–289 (In Russ., English abstract). DOI: 10.20514/2226-6704-2019-9-4-280-289

26. Marrone O., Bonsignore M.R. Blood-pressure variability in patients with obstructive sleep apnea: current perspectives. Nat. Sci. Sleep. 2018; 10: 229–242. DOI: 10.2147/NSS.S148543

27. Cuspidi C., Tadic M., Sala C., Gherbesi E., Grassi G., Mancia G. Blood pressure non-dipping and obstructive sleep apnea syndrome: a meta-analysis. J. Clin. Med. 2019; 8(9): 1367. DOI: 10.3390/jcm8091367

28. Parati G., Lombardi C., Hedner J., Bonsignore M.R., Grote L., Tkacova R., Lévy P., Riha R., Bassetti C., Narkiewicz K., Mancia G., McNicholas W.T.; EU COST Action B26 members. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur. Respir. J. 2013; 41(3): 523–538. DOI: 10.1183/09031936.00226711