Estimation of antihypertensive effect after initiating continuous positive airway pressure treatment in Japanese patients with sleep disordered breathing

Abstract

Abstract Introduction It is true that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) treatment shows antihypertensive effect by improving sympathetic nervous activity. On the other hand, we reported that CPAP treatment had a beneficial effect on hypertension, but 70% patients still remain inadequately treated. As a result, we need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment at ESC congress 2022. Purpose Our aim in this study is to estimate the antihypertensive effect after initiating CPAP treatment, also estimate the differences of CPAP effect by focusing on Japanese non-obese body. Methods All patients were conducted full night polysomnography. One-hundred eighty patients showed obstructive SDB {apnea hypopnea index (AHI) >20/hour}, and CPAP treatment were initiated. We divided into three groups by using body mass index (BMI). Group A showed BMI < 25 kg/m2 (n = 59). Group B showed 25 ≦BMI < 30 kg/m2 (n = 68), and Group C showed 30 ≦ BMI kg/m2 (n = 53). If patients had already taken blood pressure-lowering agents, they had to continue blood pressure-lowering agents without changing other agents or dose intensification. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the improvement of blood pressure to assess effectiveness of CPAP treatment after six-month follow up. Results The study group consisted of 180 SDB patients (152 males, 28 females). The mean age was 53 ± 12 years. Figure 1 showed polysomnographic data before initiating CPAP treatment. Group A was significantly lower apnea hypopnea index (AHI) than in Group B and C (p < 0.0001). Figure 2 showed the changes of blood pressure after initiating CPAP treatment (six-month). There was no significant difference respect to changes of systolic blood pressure (ΔSBP), but Group A showed the tendency for worsening SBP compared with other groups. Conclusions We could estimate that CPAP treatment had only limited effects in antihypertensive effect for Japanese patients, who especially had non-obese body and lower AHI level. We need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment.Figure