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Risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in chronic insomnia: A study on 1272 individuals referred for polysomnography
132
Arterial hypertension and vascular disease
489
Methods Demographic and polysomnographic data from 673 treated hypertensive individuals recruited from the research database of the sleep laboratory were analysed. After exclusion of the main causes of pseudo-resistance and secondary hypertension, RHT status was defined by the presence of an uncontrolled hypertension despite treatment with at least three antihypertensive agents (including a diuretic) from different classes in correct combination and at the highest tolerated doses or by the presence of controlled hypertension requiring the use of at least four antihypertensive agents. Logistic regression analyses were conducted to examine the risk of RHT associated with RLS and PMLS in treated hypertensive individuals. Results After adjustment for major confounding factors associated with RHT, multivariate logistic regression analysis revealed that frequent RLS (≥ 2 episodes/week) combined to PLMS index ≥ 26/hour [OR 2.25 (95% CI 1.37—3.69)] was significant risk factors of RHT in treated hypertensive individuals. Conclusion In treated hypertensive individuals, frequent RLS combined to PLMS index ≥ 26/hour is associated with higher risk of RHT which suggests that this pathology may be a secondary cause of RHT (such as obstructive sleep apnea syndrome and insomnia with short sleep duration) justifying the establishment of effective treatment in order to avoid the negative consequences associated with the occurrence of resistance to antihypertensive agents. Disclosure of interest The authors declare that they have no competing interest.
Risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in chronic insomnia: A study on 1272 individuals referred for polysomnography M. Hein ∗ , J.P. Lanquart , G. Loas , P. Hubain , P. Linkowski Service de psychiatrie et Laboratoire du sommeil, Hôpital Erasme, Université Libre de Bruxelles, ULB, Bruxelles, Belgique ∗ Corresponding author. E-mail address: [email protected] (M. Hein) Background Given conflicting data in the literature, the aim of this study was to examine the risk of hypertension associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of insomnia sufferers. Methods Demographic and polysomnographic data from 1272 insomnia sufferers recruited from the research database of the sleep laboratory were analyzed. Hypertension status was defined by the presence of one of the following: self-report at interview of either a physician’s diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥ 140 mm Hg or an average diastolic blood pressure ≥ 90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in insomnia sufferers. Results The prevalence of hypertension in insomnia sufferers is 30.03%. After adjustment for major confounding factors associated with hypertension, multivariate logistic regression analysis revealed that short sleep duration (< 5 hours) [OR 1.91 (95% CI 1.15—3.16)], severely reduced sleep efficiency (< 65%) [OR 1.57 (95% CI 1.01—2.45)], high sleep fragmentation (sleep fragmentation index ≥ 18/hour) [OR 1.59 (95% CI 1.10—2.30)], and long-term use of short [OR 1.78 (95% CI 1.03—3.09)] or intermediate [OR 2.10 (95% CI 1.12—3.92)] half-life benzodiazepine receptor agonists were significant risk factors of hypertension in insomnia sufferers. Conclusion In insomnia sufferers, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of hypertension. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and hypertension. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.379 140
Risk of resistant hypertension associated with restless legs syndrome and periodic limb movements during sleep: A study on 673 treated hypertensive individuals M. Hein ∗ , J.P. Lanquart , P. Hubain , G. Loas Service de psychiatrie et Laboratoire du sommeil, Hôpital Erasme, Université Libre de Bruxelles, ULB, Bruxelles, Belgique ∗ Corresponding author. E-mail address: [email protected] (M. Hein) Background Given the limited data available in the literature, the aim of this study was to examine the risk of resistant hypertension (RHT) associated with restless legs syndrome (RLS) and periodic limb movements during sleep (PMLS) in a large sample of treated hypertensive individuals.
https://doi.org/10.1016/j.acvdsp.2019.09.380 622
Hypertension is not always cured after unilateral adrenalectomy in patients with endocrine secondary hypertension A. Gonot , A. Gallo , E. Bruckert , X. Girerd ∗ Unité Prévention cardio vasculaire, Hôpital Salpêtrière, Paris, France ∗ Corresponding author. E-mail address: [email protected] (X. Girerd) Background It is commonly accepted that adrenalectomy cures hypertension in secondary endocrine hypertensions. The purpose of this study was to evaluate the percentage of cure of hypertension after adrenal surgery in three causes of endocrine hypertension: Conn’s adenoma, pheochromocytoma and cortisolic adenoma. Methods Patients with hypertension with a radiological and hormonal check-up confirming the diagnosis of endocrine hypertension by Conn’s adenoma (55 cases), pheochromocytoma (39 cases) or cortisolic adenoma (15 cases) have had unilateral adrenal surgery. Before the surgery, patients were treated with anti-anhypertensive drugs specific to each cause allowing the control of blood pressure in home blood pressure monitoring in 89% of subjects. In the 3 months following surgery, blood pressure was reassessed by home monitoring after stopping antihypertensive drugs. Results Healing of hypertension was observed in 69% of pheochromocytomas, 60% of Conn’s adenomas and 40% of cortisolic adenomas. In subjects with Conn’s adenoma the healing characteristics are: age less than 40 years, female sex, normalization of blood pressure before surgery with spironolactone treatment and normality of the opposite adrenal gland on CT. For pheochromocytoma, parameters linked with hypertension healing were normalization of blood pressure before surgery with specific medical treatment and age less than 40 years. For cortisol adenoma, young age at surgery is also linked with healing hypertension. Conclusion This work indicates that in secondary hypertensions, adrenal surgery does not achieve a cure in all patients in the months following surgery. The characteristics that predict the cure of hyper-
Arterial hypertension and vascular disease
489
Methods Demographic and polysomnographic data from 673 treated hypertensive individuals recruited from the research database of the sleep laboratory were analysed. After exclusion of the main causes of pseudo-resistance and secondary hypertension, RHT status was defined by the presence of an uncontrolled hypertension despite treatment with at least three antihypertensive agents (including a diuretic) from different classes in correct combination and at the highest tolerated doses or by the presence of controlled hypertension requiring the use of at least four antihypertensive agents. Logistic regression analyses were conducted to examine the risk of RHT associated with RLS and PMLS in treated hypertensive individuals. Results After adjustment for major confounding factors associated with RHT, multivariate logistic regression analysis revealed that frequent RLS (≥ 2 episodes/week) combined to PLMS index ≥ 26/hour [OR 2.25 (95% CI 1.37—3.69)] was significant risk factors of RHT in treated hypertensive individuals. Conclusion In treated hypertensive individuals, frequent RLS combined to PLMS index ≥ 26/hour is associated with higher risk of RHT which suggests that this pathology may be a secondary cause of RHT (such as obstructive sleep apnea syndrome and insomnia with short sleep duration) justifying the establishment of effective treatment in order to avoid the negative consequences associated with the occurrence of resistance to antihypertensive agents. Disclosure of interest The authors declare that they have no competing interest.
Risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in chronic insomnia: A study on 1272 individuals referred for polysomnography M. Hein ∗ , J.P. Lanquart , G. Loas , P. Hubain , P. Linkowski Service de psychiatrie et Laboratoire du sommeil, Hôpital Erasme, Université Libre de Bruxelles, ULB, Bruxelles, Belgique ∗ Corresponding author. E-mail address: [email protected] (M. Hein) Background Given conflicting data in the literature, the aim of this study was to examine the risk of hypertension associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of insomnia sufferers. Methods Demographic and polysomnographic data from 1272 insomnia sufferers recruited from the research database of the sleep laboratory were analyzed. Hypertension status was defined by the presence of one of the following: self-report at interview of either a physician’s diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥ 140 mm Hg or an average diastolic blood pressure ≥ 90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of hypertension associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in insomnia sufferers. Results The prevalence of hypertension in insomnia sufferers is 30.03%. After adjustment for major confounding factors associated with hypertension, multivariate logistic regression analysis revealed that short sleep duration (< 5 hours) [OR 1.91 (95% CI 1.15—3.16)], severely reduced sleep efficiency (< 65%) [OR 1.57 (95% CI 1.01—2.45)], high sleep fragmentation (sleep fragmentation index ≥ 18/hour) [OR 1.59 (95% CI 1.10—2.30)], and long-term use of short [OR 1.78 (95% CI 1.03—3.09)] or intermediate [OR 2.10 (95% CI 1.12—3.92)] half-life benzodiazepine receptor agonists were significant risk factors of hypertension in insomnia sufferers. Conclusion In insomnia sufferers, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of hypertension. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and hypertension. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.379 140
Risk of resistant hypertension associated with restless legs syndrome and periodic limb movements during sleep: A study on 673 treated hypertensive individuals M. Hein ∗ , J.P. Lanquart , P. Hubain , G. Loas Service de psychiatrie et Laboratoire du sommeil, Hôpital Erasme, Université Libre de Bruxelles, ULB, Bruxelles, Belgique ∗ Corresponding author. E-mail address: [email protected] (M. Hein) Background Given the limited data available in the literature, the aim of this study was to examine the risk of resistant hypertension (RHT) associated with restless legs syndrome (RLS) and periodic limb movements during sleep (PMLS) in a large sample of treated hypertensive individuals.
https://doi.org/10.1016/j.acvdsp.2019.09.380 622
Hypertension is not always cured after unilateral adrenalectomy in patients with endocrine secondary hypertension A. Gonot , A. Gallo , E. Bruckert , X. Girerd ∗ Unité Prévention cardio vasculaire, Hôpital Salpêtrière, Paris, France ∗ Corresponding author. E-mail address: [email protected] (X. Girerd) Background It is commonly accepted that adrenalectomy cures hypertension in secondary endocrine hypertensions. The purpose of this study was to evaluate the percentage of cure of hypertension after adrenal surgery in three causes of endocrine hypertension: Conn’s adenoma, pheochromocytoma and cortisolic adenoma. Methods Patients with hypertension with a radiological and hormonal check-up confirming the diagnosis of endocrine hypertension by Conn’s adenoma (55 cases), pheochromocytoma (39 cases) or cortisolic adenoma (15 cases) have had unilateral adrenal surgery. Before the surgery, patients were treated with anti-anhypertensive drugs specific to each cause allowing the control of blood pressure in home blood pressure monitoring in 89% of subjects. In the 3 months following surgery, blood pressure was reassessed by home monitoring after stopping antihypertensive drugs. Results Healing of hypertension was observed in 69% of pheochromocytomas, 60% of Conn’s adenomas and 40% of cortisolic adenomas. In subjects with Conn’s adenoma the healing characteristics are: age less than 40 years, female sex, normalization of blood pressure before surgery with spironolactone treatment and normality of the opposite adrenal gland on CT. For pheochromocytoma, parameters linked with hypertension healing were normalization of blood pressure before surgery with specific medical treatment and age less than 40 years. For cortisol adenoma, young age at surgery is also linked with healing hypertension. Conclusion This work indicates that in secondary hypertensions, adrenal surgery does not achieve a cure in all patients in the months following surgery. The characteristics that predict the cure of hyper-