The association between blood pressure control and long-term cardiovascular outcomes in hypertension coexists with obstructive sleep apnea

Abstract

Abstract Purpose: The goal of blood pressure (BP) control will be lower when hypertensive patients have comorbidities that can affect the risk of cardiovascular diseases. But, the goal of BP control for hypertensive patients who coexists with obstructive sleep apnea (OSA) is not discussed, which is a special population at high risk of cardiovascular diseases. Patients and methods: Using data from the UROSAH Study, we enrolled 3267 participants who were diagnosed with hypertension and performed polysomnography during 2011-2013 to explore the association between BP control and long-term major adverse cardiovascular and cerebrovascular events (MACCEs). Outcomes of interest were the levels of BP control, MACCEs, cardiac events and cerebrovascular events. Then we calculated the cumulative incidence of MACCEs and performed Cox proportional hazards with stepwise models. Results: 379 of 3267 patients experienced MACCEs during a median follow-up of 7.0 years. After full risk adjustment, BP control of 120-140/80-90mmHg was associated with the lowest risk of cerebrovascular events (HR: 0.53, 95%CI:0.35-0.82) rather than MACCEs and cardiac events in the total cohort. The association did not changed much in patients with OSA. When the SBP and DBP were discussed separately, the SBP control of 120-140mmHg or <120 mmHg was associated with the decreased incidence of MACCEs and cerebrovascular events. When DBP control<80 mmHg, the risk of cerebrovascular events showed 54% decrease[(HR:0.46, 95%CI: 0.25-0.88)] in patients with hypertension and OSA. Conclusion: In this retrospective study, antihypertensive-drug-induced BP control at 120-140/80-90mmHg showed possible beneficial effect on incident MACCEs. However, SBP≤120mmHg or DBP<80mmHg respectively showed the significant benefit to reduce incident cerebrovascular events in hypertensives with OSA.