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Morbidity in Patients with Uncontrolled Hypertension and Obstructive Sleep Apnea: Updates of Baseline Profile of the MORPHEOS study.
The impact of obstructive sleep apnea (OSA) treatment with continuous positive airway pressure (CPAP) on blood pressure (BP) is not well established. Previous studies presented one or more of the following limitations: 1. Adherence to antihypertensive medications was not performed; 2. Inclusion of patients with controlled BP at baseline; 3. Absence of a placebo arm; 4. No systematical exclusion of secondary hypertension (HTN).
Evaluate the impact of OSA treatment with CPAP on central BP and peripheral BP.
The MORPHEOS is an ongoing multicenter (n=6) Brazilian randomized study designed to measure the cardiovascular impact of 6 months’ treatment with CPAP or placebo (nasal strips) in patients with uncontrolled HTN and moderate to severe OSA (apnea-hypopnea index, AHI, >15 events/h by portable sleep monitoring – Embletta GoldTM). Uncontrolled HTN was defined by office systolic BP ≥140mmHg OR diastolic BP ≥90mmHg AND elevation on at least one parameter of 24-hour ambulatory BP monitoring despite the regular use (evaluated by pill count for one month – run-in period) of at least one antihypertensive medication. The primary endpoint is central BP (SphygmoCor). Secondary outcomes include office BP, 24-hour ambulatory BP, target-organ damage as evaluated by echocardiography (Vivid E95) and arterial stiffness by pulse wave velocity (Complior). The patients are followed every week (first month) and once a month there after. During the follow-up, we performed adherence to medications by pill count and standard procedures for checking OSA and nasal strips use.
This ongoing study evaluated 415 patients. One-hundred thirty two patients (31.8%) were excluded due to BP control run-in period. In addition, 22 participants (5.3%) were excluded due to secondary HTN, 80 (19.3%) due to an AHI <15 events/h and 49 (11.8%) due to other causes. So far, 132 patients were randomized (63.6% men, age 53±12 years, body mass index 32.6±3.9Kg/m2). Co-morbidities were common in this population (for instance, dyslipidemia 47%, diabetes mellitus 39%). The AHI was 43±23 events/h and lowest oxygen saturation was 76±9%. The office systolic BP was 154±14 mmHg and office diastolic BP was 92±13 mmHg.
The MORPHEOS is intending to surpass the main limitations of the previous studies to explore the cardiovascular impact of OSA treatment with CPAP in patients with HTN.
hypertension, obstructive sleep apnea, continuous positive airway pressure
Fernanda Carolina Silva Guimaraes Cruz, Luciano Ferreira Drager, Daniel B C Queiroz, Marcelo L C Vieira, Rodrigo P Pedrosa, Flávio D Fuchs, Denis Martinez, Geruza A Silva, Paulo A Lotufo, Geraldo Lorenzi-Filho