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Numbers of Antihypertensive Agents to Control Blood Pressure in Obstructive Sleep Apnea Caused Hypertensive Patients
Abstracts
efficacy and safety of the three novel oral anticoagulants (NOACs) in patients undergoing DCCV for atrial arrhythmias. Methods: We compared warfarin to NOACs for patients undergoing DCCV at Wollongong Hospital between January 2014 and December 2015. All patients underwent transoesophageal echocardiography (TOE) prior to cardioversion to exclude left atrial appendage (LAA) thrombus. We compared the incidence of stroke and major bleeding events requiring intervention between warfarin and the three NOACs during a minimum of three months follow up. Results: In total, 228 patients had no evidence of LAA thrombus and underwent DCCV; 129 (56.6%) males with a median age of 68 +/- 12 and median CHA2 DS2 VASc score of 3. Patient characteristics were similar between agents. Warfarin was utilised in 101 (44.3%) patients, apixaban in 49 (21.5%), rivaroxaban in 47(20.6%) and dabigatran in 31 (13.6%) with a steady increase in NOAC utilisation from 2014 to 2015. There were two (2.0%) strokes in the warfarin group and 1 in the NOAC group (0.9%) and 3 (3.0%) bleeding events in the warfarin group and 2 (1.7%) in the NOAC group (p = NS). Zero patients taking apixaban had a documented stroke or bleeding event. Conclusion: In our institution, NOAC has been increasingly used to prevent thromboembolic events in cardioversion procedures. In our experience, NOACs appear safe in comparison to warfarin with low rates of stroke and bleeding post DCCV. http://dx.doi.org/10.1016/j.hlc.2016.06.041 41 Numbers of Antihypertensive Agents to Control Blood Pressure in Obstructive Sleep Apnea Caused Hypertensive Patients S. Silaruks ∗ , K. Sawanyawisuth Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Obstructive sleep apnea (OSA) is a common cause of hypertension. Successful treatment with continuous positive airway pressure (CPAP) may reduce numbers of antihypertensive agents in the Western population. There is limited data on the effects of CPAP treatment and numbers of antihypertensive agents in Asian setting. The study was a retrospective cohort study and conducted at Sleep/hypertension clinic, single institute. The inclusion criteria were adult hypertensive patients with apnea-hypopnea index (AHI) of more than five events/ hour, no evidence of other secondary hypertension, and continuously on CPAP therapy at least three months. Numbers of antihypertensive medications were assessed. There were 51 patients diagnosed as secondary hypertension from OSA. Of these, 18 patients (35.29%) were be able to comply with CPAP therapy and had well controlled hypertension. The average AHI of these 18 patients (mean age 58 years) was 20.9 events/ hour, the mean body mass index was 30.53 kg/ m2 . The average number of antihypertensive medication was 1.11; calcium channel blocker was the most common prescribed medication. Snoring was found in all
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patients, daytime sleepiness in 4, reflux oesophagitis and unexplained nocturia in 6 each. Macroglossia was the most common OSA anatomical risk factor (7 patients; 38.89%) with the average neck circumference of 71 cm. In OSA induced hypertensive patients, the average number of antihypertensive medication was 1.11 to control hypertension in Asian setting. Well compliance with CPAP therapy might be considered as an “alternative, effective” intervention to control high blood pressure in OSA patients. http://dx.doi.org/10.1016/j.hlc.2016.06.042 42 Quantification of Pulmonary Artery Flow Dynamics and Disruption in Pulmonary Artery Hypertension Using 4D-Flow K. Broadhouse 1 , F. Callaghan 1,∗ , K. Karimi 1,3 , D. Celermajer 2 , G. Figtree 3 , S. Grieve 1 1 Sydney
Translational Imaging Laboratory, Australia 2 Sydney Medical School, University of Sydney, Camperdown, Australia 3 Department of Cardiology, Royal North Shore Hospital, Sydney Australia Introduction: Pulmonary arterial hypertension (PAH) is complex, inadequately understood and prognosis remains poor. Accurate assessment of the pulmonary circulation and resultant flow patterns is crucial for management. 4D phase contrast (PC) MRI is an accurate comprehensive technique to assess flow patterns in PAH [1]. Here we present a preliminary analysis of pulmonary blood flow patterns in PAH patients and a normal cohort (controls) to investigate the resultant circulation. Method: 4D-flow was acquired in 11 PAH patients and 11 controls. Net flow was quantified within the main (MPA) left (LPA) and right (RPA) pulmonary artery, contribution of flow through the left and right side of the MPA to the RPA and LPA were calculated as a measure of flow efficiency. Flow patterns were visualised from particle traces (see Figure) for qualitative comparison. A measure of disturbance from laminar flow and its persistence were quantified in the MPA, RPA and LPA from decomposition of velocity vectors to circumferential and axial components. Results: PA flow volume was significantly reduced in patients by 40% p<0.0001. Disturbance magnitude and persistence of disrupted flow was significantly increased in MPA and RPA in PAH p<0.001. Particle traces indicated dramatically reduced circulation efficiency from aberrant chaotic flow patterns and increased PA transit time. Conclusion: This study determined the degree of aberrant flow patterns in PAH patients. This study provides insight into PAH circulation, yet highlights the need for further work to establish association between RV function and PA circulation.
efficacy and safety of the three novel oral anticoagulants (NOACs) in patients undergoing DCCV for atrial arrhythmias. Methods: We compared warfarin to NOACs for patients undergoing DCCV at Wollongong Hospital between January 2014 and December 2015. All patients underwent transoesophageal echocardiography (TOE) prior to cardioversion to exclude left atrial appendage (LAA) thrombus. We compared the incidence of stroke and major bleeding events requiring intervention between warfarin and the three NOACs during a minimum of three months follow up. Results: In total, 228 patients had no evidence of LAA thrombus and underwent DCCV; 129 (56.6%) males with a median age of 68 +/- 12 and median CHA2 DS2 VASc score of 3. Patient characteristics were similar between agents. Warfarin was utilised in 101 (44.3%) patients, apixaban in 49 (21.5%), rivaroxaban in 47(20.6%) and dabigatran in 31 (13.6%) with a steady increase in NOAC utilisation from 2014 to 2015. There were two (2.0%) strokes in the warfarin group and 1 in the NOAC group (0.9%) and 3 (3.0%) bleeding events in the warfarin group and 2 (1.7%) in the NOAC group (p = NS). Zero patients taking apixaban had a documented stroke or bleeding event. Conclusion: In our institution, NOAC has been increasingly used to prevent thromboembolic events in cardioversion procedures. In our experience, NOACs appear safe in comparison to warfarin with low rates of stroke and bleeding post DCCV. http://dx.doi.org/10.1016/j.hlc.2016.06.041 41 Numbers of Antihypertensive Agents to Control Blood Pressure in Obstructive Sleep Apnea Caused Hypertensive Patients S. Silaruks ∗ , K. Sawanyawisuth Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Obstructive sleep apnea (OSA) is a common cause of hypertension. Successful treatment with continuous positive airway pressure (CPAP) may reduce numbers of antihypertensive agents in the Western population. There is limited data on the effects of CPAP treatment and numbers of antihypertensive agents in Asian setting. The study was a retrospective cohort study and conducted at Sleep/hypertension clinic, single institute. The inclusion criteria were adult hypertensive patients with apnea-hypopnea index (AHI) of more than five events/ hour, no evidence of other secondary hypertension, and continuously on CPAP therapy at least three months. Numbers of antihypertensive medications were assessed. There were 51 patients diagnosed as secondary hypertension from OSA. Of these, 18 patients (35.29%) were be able to comply with CPAP therapy and had well controlled hypertension. The average AHI of these 18 patients (mean age 58 years) was 20.9 events/ hour, the mean body mass index was 30.53 kg/ m2 . The average number of antihypertensive medication was 1.11; calcium channel blocker was the most common prescribed medication. Snoring was found in all
S19
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patients, daytime sleepiness in 4, reflux oesophagitis and unexplained nocturia in 6 each. Macroglossia was the most common OSA anatomical risk factor (7 patients; 38.89%) with the average neck circumference of 71 cm. In OSA induced hypertensive patients, the average number of antihypertensive medication was 1.11 to control hypertension in Asian setting. Well compliance with CPAP therapy might be considered as an “alternative, effective” intervention to control high blood pressure in OSA patients. http://dx.doi.org/10.1016/j.hlc.2016.06.042 42 Quantification of Pulmonary Artery Flow Dynamics and Disruption in Pulmonary Artery Hypertension Using 4D-Flow K. Broadhouse 1 , F. Callaghan 1,∗ , K. Karimi 1,3 , D. Celermajer 2 , G. Figtree 3 , S. Grieve 1 1 Sydney
Translational Imaging Laboratory, Australia 2 Sydney Medical School, University of Sydney, Camperdown, Australia 3 Department of Cardiology, Royal North Shore Hospital, Sydney Australia Introduction: Pulmonary arterial hypertension (PAH) is complex, inadequately understood and prognosis remains poor. Accurate assessment of the pulmonary circulation and resultant flow patterns is crucial for management. 4D phase contrast (PC) MRI is an accurate comprehensive technique to assess flow patterns in PAH [1]. Here we present a preliminary analysis of pulmonary blood flow patterns in PAH patients and a normal cohort (controls) to investigate the resultant circulation. Method: 4D-flow was acquired in 11 PAH patients and 11 controls. Net flow was quantified within the main (MPA) left (LPA) and right (RPA) pulmonary artery, contribution of flow through the left and right side of the MPA to the RPA and LPA were calculated as a measure of flow efficiency. Flow patterns were visualised from particle traces (see Figure) for qualitative comparison. A measure of disturbance from laminar flow and its persistence were quantified in the MPA, RPA and LPA from decomposition of velocity vectors to circumferential and axial components. Results: PA flow volume was significantly reduced in patients by 40% p<0.0001. Disturbance magnitude and persistence of disrupted flow was significantly increased in MPA and RPA in PAH p<0.001. Particle traces indicated dramatically reduced circulation efficiency from aberrant chaotic flow patterns and increased PA transit time. Conclusion: This study determined the degree of aberrant flow patterns in PAH patients. This study provides insight into PAH circulation, yet highlights the need for further work to establish association between RV function and PA circulation.