Impact of hypertension on cardiovascular outcomes and all-cause mortality in older patients with obstructive sleep apnea

Abstract

Abstract Background and Aim: Although hypertension and obstructive sleep apnea (OSA) frequently coexist, few prospective cohort studies have examined the relationship between hypertension and the risk of cardiovascular events and mortality in older patients with OSA. This study sought to determine how hypertension affected cardiovascular incidents and death in older patients with OSA. Methods: This multicenter, prospective cohort study comprised a sample of 1,113 older individuals (≥60 years) with OSA between January 2015 and October 2017. The following data were gathered: baseline demographics, sleep measures, clinical traits, and follow-up results. The mean follow-up period was 42 months (range: 1–72 months). Major adverse cardiovascular events (MACE) were the primary outcome. All-cause mortality, MACE subcomponents, and a composite of all events served as the secondary end points. Results: A total of 706 (63.4%) OSA patients had hypertension. The risk of MACE (HR=2.13, 95%CI: 1.28–3.57, p<0.05); hospitalization for unstable angina (HR=2.03, 95%CI: 1.03–4.00, p<0.05); and a composite of all events (HR=1.75, 95%CI: 1.12–2.73, p<0.05) was higher in older OSA patients who had hypertension, according to a multivariable Cox regression analysis. In a subgroup analysis, male patients, those under 75 years, and those with moderate-to-severe OSA had increased the adjusted HRs for MACE by hypertension. However, there were no discernible changes in the incidence of cardiovascular death, all-cause mortality, myocardial infarction, or heart failure between patients with and without hypertension (p>0.05). Conclusions: In older OSA patients, hypertension is independently linked to a higher risk of MACE, hospitalization for unstable angina, and a composite of all events. Male sex, age<75 years, and moderate-to-severe OSA, coupled with hypertension, presented a particularly high MACE risk.