OSA remains a risk factor for cardiac events even in hypertensive patients under treatment: The UROSAH data

Abstract

Objectives: Both obstructive sleep apnea (OSA) and hypertension are risk factors of cardiovascular diseases (CVDs). The study aimed to observe the effect of the coexistence of OSA and hypertension on CVDs and evaluate the impact of antihypertensive treatment on CVDs outcomes in this population. Study Design: This is a retrospective cohortstudy. Methods: Hypertensive patients who underwent polysomnography (PSG) test in Jan 2011 to Dec 2013 were enrolled. OSA was defined as apnea hypopnea index(AHI)≥ 5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of non-fatal myocardial infarction, non-fatal stroke, revascularization, cardiac rehospitalization due to unstable angina or heart failure and all-cause death. The effect of the coexistence of OSA and hypertension on MACCE was explored by Cox regression analysis. Results: Overall, 415 individuals out of 3329 hypertensives experienced extended MACCE. At a median follow-up of 7.0 years, the incidence of extended MACCE was significantly higher in OSA group than in non-OSA group (hazard ratio [HR]: 1.59; 95% confidence interval [CI]:1.27-1.99; P<0.001). Totally, OSA patients had a 57% increased risk of cardiac events than subjects without OSA [HR(95%CI):1.57 (1.04-2.39), P=0.034] and the association did not change in further sensitivity analysis. Especially in uncontrolled hypertension, OSA showed a 93% increased risk of cardiac events compared to patients without OSA(P=0.036) . Conclusion: OSA remains a risk factor of cardiac events, while the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control.