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Vol. 42. Issue 1.
Pages 14-20 (January 2006)
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Vol. 42. Issue 1.
Pages 14-20 (January 2006)
Original Articles
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Sleep-Disordered Breathing in Patients With Difficult-to-Control Hypertension
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M.A. Martínez-Garcíaa,
Corresponding author
med013416@saludalia.com

Correspondence: Dr. M.A. Martínez-García. Unidad de Neumología. Servicio de Medicina Interna. Hospital General de Requena. Pasaje Casablanca, s/n. 46230 Requena. Valencia. España
, R. Gómez-Aldaravíb, T. Gil-Martínezc, J.J. Soler-Cataluñaa, B. Bernácer-Alperac, P. Román-Sánchezc
a Unidad de Neumología, Hospital General de Requena, Requena, Valencia, Spain
b Unidad de Cardiología, Hospital General de Requena, Requena, Valencia, Spain
c Servicio de Medicina Interna, Hospital General de Requena, Requena, Valencia, Spain
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Objective

To analyze the relationship between sleep-disordered breathing and difficult-to-control arterial hypertension.

Patients and method

Patients were considered to have difficult-to-control hypertension when mean systolic blood pressure was 125 mm Hg or higher and/or mean systolic blood pressure was more than or equal to 80 mm Hg (as recorded during 2 24-hour ambulatory monitoring studies) despite the use of 3 or more antihypertensive drugs. Respiratory polygraphy using the AutoSet device (ResMed Corp, Sydney, Australia) was then performed to study sleep-disordered breathing in all patients.

Results

Forty-nine patients with a mean (SD) age of 68.1 (9.1) years, mean systolic and diastolic pressures of 152.5 (13)/89.2 (8.5) mm Hg, and an average of 3.5 prescribed drugs were included in the study. The mean apnea-hypopnea index (AHI) was 26.2 (19.5) and events were predominantly obstructive. Patients with severe sleep apnea-hypopnea syndrome (SAHS) (AHI ≥ 30; 40.8%) showed more uncontrolled daytime (P=. 017) and nighttime (P = .033) systolic pressure than the rest, as well as higher daytime diastolic pressure (P = .035) and a greater consumption of drugs than those without severe SAHS (AHI < 10; 28.6%) (P = .041). The study population as a whole showed a significant correlation between blood pressure and obesity. There was a significant correlation (adjusted for age and sex) with AHI only in patients with SAHS. AHI was found to be the independent predictor with the greatest effect on blood pressure in these patients.

Conclusions

Prevalence of SAHS was very high in patients with difficult-to-control hypertension. In patients with SAHS, AHI was found to be the independent predictor with the greatest affect on arterial blood pressure.

Key words:
Refractary hypertension Sleep apnea-hypopnea syndrome
Respiratory polygraphy
Cardiovascular risk factors
Objetivo

Analizar la relación existente entre los trastornos respiratorios durante el sueño y la hipertensión arterial de difícil control (HTAr).

Patientes y método

Se consideró HTAr cuando las cifras medias de la presión arterial sistólica (PAS) eran mayores o iguales a 125 mmHg y/o la diastólica (PAD) era igual o superior a 80 mmHg según el registro de 2 estudios de monitorización ambulatoria durante 24 h a pesar de la utilización de 3 o más fármacos antihipertensivos. Se realizó posteriormente una poligrafía respiratoria (Autoset) para el estudio de los trastornos respiratorios durante el sueño en todos los pacientes.

Resultados

Se incluyó en el estudio a 49 pacientes con una media (± desviación estándar) de edad de 68,1 ± 9,1 años, PAS/PAD media de 152,5 ±13/89,2 ±8,5 mmHg y una media de 3,5 fármacos prescritos. El índice de apneas-hipopneas (IAH) fue de 26,2 ± 19,5, de predominio obstructivo. Los pacientes con síndrome de apneas-hipopneas durante el sueño (SAHS) grave (IAH ≥ 30; 40,8%) presentaron mayor descontrol de la PAS tanto diurna (p = 0,017) como nocturna (p = 0,033) que el resto de pacientes, así como mayor PAD diurna (p = 0,035) y toma de un mayor número de fármacos que quienes no lo presentaban (IAH < 10; 28,6%) (p = 0,041). Tomados en su conjunto, los pacientes presentaron una correlación significativa entre las cifras de la presión arterial y la obesidad, además de existir una correlación ajustada significativa con el IAH sólo en los pacientes con SAHS. El IAH se mostró como el predictor independiente que más influyó en las cifras de la presión arterial de estos pacientes.

Conclusiones

En pacientes con HTAr la prevalencia de SAHS fue muy elevada. En los pacientes con SAHS, el IAH se mostró como el factor predictivo independiente más importante de las cifras de presión arterial.

Palabras clave:
Hipertensión de difícil control
Síndrome de apneashipopneas durante el sueño
Poligrafía respiratoria
Factores de riesgo cardiovascular
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Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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