Original Articles
Sleep-Disordered Breathing in Patients With Difficult-to-Control Hypertension
M.A. Martínez-Garcíaa,
, R. Gómez-Aldaravíb, T. Gil-Martínezc, J.J. Soler-Cataluñaa, B. Bernácer-Alperac, P. Román-Sánchezc
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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
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
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Román-Sánchez" "autores" => array:6 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "M.A." "apellidos" => "Martínez-García" "email" => array:1 [ 0 => "med013416@saludalia.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Gómez-Aldaraví" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "T." "apellidos" => "Gil-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "J.J." 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"apellidos" => "Román-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Neumología, Hospital General de Requena, Requena, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Unidad de Cardiología, Hospital General de Requena, Requena, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General de Requena, Requena, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "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" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-04-11" "fechaAceptado" => "2005-09-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154171" "palabras" => array:3 [ 0 => "Refractary hypertension Sleep apnea-hypopnea syndrome" 1 => "Respiratory polygraphy" 2 => "Cardiovascular risk factors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154170" "palabras" => array:4 [ 0 => "Hipertensión de difícil control" 1 => "Síndrome de apneashipopneas durante el sueño" 2 => "Poligrafía respiratoria" 3 => "Factores de riesgo cardiovascular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the relationship between sleep-disordered breathing and difficult-to-control arterial hypertension.</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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 (<span class="elsevierStyleItalic">P</span>=. 017) and nighttime (<span class="elsevierStyleItalic">P</span> = .033) systolic pressure than the rest, as well as higher daytime diastolic pressure (<span class="elsevierStyleItalic">P</span> = .035) and a greater consumption of drugs than those without severe SAHS (AHI < 10; 28.6%) (<span class="elsevierStyleItalic">P</span> = .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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar la relación existente entre los trastornos respiratorios durante el sueño y la hipertensión arterial de difícil control (HTAr).</p> <span class="elsevierStyleSectionTitle">Patientes y método</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of sleep apnea and hypertension in a large community-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "FJ Nieto" 1 => "T Young" 2 => "BK Lind" 3 => "E Sharar" 4 => "JM Samet" 5 => "S Redline" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2000" "volumen" => "283" "paginaInicial" => "1829" "paginaFinal" => "1836" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10770144" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Population-based study of sleep-disordered breathing as a risk factor for hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T Young" 1 => "P Peppard" 2 => "M Palta" 3 => "KM Hla" 4 => "L Finn" 5 => "B Morgan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1997" "volumen" => "157" "paginaInicial" => "1746" "paginaFinal" => "1752" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9250236" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep apnea and hypertension. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 28 | 18 | 46 |
| 2024 September | 26 | 12 | 38 |
| 2024 August | 40 | 28 | 68 |
| 2024 July | 22 | 21 | 43 |
| 2024 June | 25 | 16 | 41 |
| 2024 May | 34 | 23 | 57 |
| 2024 April | 12 | 24 | 36 |
| 2024 March | 17 | 16 | 33 |
| 2024 February | 24 | 23 | 47 |
| 2023 March | 1 | 4 | 5 |
| 2023 February | 18 | 18 | 36 |
| 2023 January | 14 | 20 | 34 |
| 2022 December | 24 | 20 | 44 |
| 2022 November | 16 | 20 | 36 |
| 2022 October | 24 | 34 | 58 |
| 2022 September | 17 | 14 | 31 |
| 2022 August | 19 | 38 | 57 |
| 2022 July | 19 | 42 | 61 |
| 2022 June | 11 | 35 | 46 |
| 2022 May | 18 | 26 | 44 |
| 2022 April | 17 | 26 | 43 |
| 2022 March | 20 | 38 | 58 |
| 2022 February | 12 | 36 | 48 |
| 2022 January | 20 | 24 | 44 |
| 2021 December | 16 | 47 | 63 |
| 2021 November | 14 | 43 | 57 |
| 2021 October | 27 | 44 | 71 |
| 2021 September | 14 | 44 | 58 |
| 2021 August | 10 | 22 | 32 |
| 2021 July | 14 | 21 | 35 |
| 2021 June | 14 | 29 | 43 |
| 2021 May | 14 | 15 | 29 |
| 2021 April | 32 | 22 | 54 |
| 2021 March | 16 | 23 | 39 |
| 2021 February | 9 | 15 | 24 |
| 2021 January | 13 | 11 | 24 |
| 2020 December | 8 | 17 | 25 |
| 2020 November | 13 | 12 | 25 |
| 2020 October | 8 | 3 | 11 |
| 2020 September | 7 | 10 | 17 |
| 2020 August | 7 | 7 | 14 |
| 2020 July | 21 | 12 | 33 |
| 2020 June | 21 | 6 | 27 |
| 2020 May | 34 | 11 | 45 |
| 2020 April | 28 | 10 | 38 |
| 2020 March | 21 | 11 | 32 |
| 2020 February | 17 | 9 | 26 |
| 2020 January | 27 | 11 | 38 |
| 2019 December | 15 | 10 | 25 |
| 2019 November | 12 | 10 | 22 |
| 2019 October | 9 | 5 | 14 |
| 2019 September | 16 | 12 | 28 |
| 2019 August | 14 | 6 | 20 |
| 2019 July | 10 | 14 | 24 |
| 2019 June | 4 | 6 | 10 |
| 2019 May | 16 | 8 | 24 |
| 2019 April | 23 | 14 | 37 |
| 2019 March | 9 | 15 | 24 |
| 2019 February | 8 | 15 | 23 |
| 2019 January | 3 | 4 | 7 |
| 2018 December | 7 | 18 | 25 |
| 2018 November | 15 | 11 | 26 |
| 2018 October | 10 | 14 | 24 |
| 2018 September | 8 | 11 | 19 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 5 | 6 | 11 |
| 2018 March | 4 | 4 | 8 |
| 2018 February | 4 | 6 | 10 |
| 2018 January | 4 | 9 | 13 |
| 2017 December | 4 | 5 | 9 |
| 2017 November | 6 | 4 | 10 |
| 2017 October | 4 | 9 | 13 |
| 2017 September | 5 | 4 | 9 |
| 2017 August | 8 | 10 | 18 |
| 2017 July | 2 | 2 | 4 |
| 2017 June | 12 | 8 | 20 |
| 2017 May | 6 | 9 | 15 |
| 2017 April | 1 | 3 | 4 |
| 2017 March | 4 | 8 | 12 |
| 2017 February | 1 | 4 | 5 |
| 2017 January | 1 | 0 | 1 |
| 2016 December | 8 | 8 | 16 |
| 2016 November | 6 | 6 | 12 |
| 2016 October | 12 | 5 | 17 |
| 2016 September | 9 | 10 | 19 |
| 2016 August | 5 | 3 | 8 |
| 2016 July | 10 | 4 | 14 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 42 | 1 | 43 |
| 2015 September | 35 | 15 | 50 |
| 2015 August | 24 | 12 | 36 |
| 2015 July | 27 | 3 | 30 |
| 2015 June | 40 | 10 | 50 |
| 2015 May | 30 | 6 | 36 |
| 2015 April | 20 | 6 | 26 |
| 2015 March | 27 | 13 | 40 |
| 2015 February | 10 | 6 | 16 |
| 2015 January | 16 | 6 | 22 |
| 2014 December | 22 | 3 | 25 |
| 2014 November | 14 | 8 | 22 |
| 2014 October | 34 | 9 | 43 |
| 2014 September | 17 | 8 | 25 |
| 2014 August | 24 | 16 | 40 |
| 2014 July | 23 | 7 | 30 |
| 2014 June | 40 | 8 | 48 |
| 2014 May | 35 | 10 | 45 |
| 2014 April | 38 | 8 | 46 |
| 2014 March | 44 | 6 | 50 |
| 2014 February | 32 | 13 | 45 |
| 2014 January | 20 | 8 | 28 |
| 2013 December | 37 | 10 | 47 |
| 2013 November | 21 | 4 | 25 |
| 2013 October | 28 | 11 | 39 |
| 2013 September | 33 | 7 | 40 |
| 2013 August | 34 | 15 | 49 |
| 2013 July | 44 | 14 | 58 |
| 2013 June | 26 | 9 | 35 |
| 2013 May | 29 | 5 | 34 |
| 2013 April | 28 | 4 | 32 |
| 2013 March | 15 | 3 | 18 |
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