OSA (Obstructive Apnea) is an important cause of hypertension, and it is the first cause.OSA and hypertension can be mutually causal, forming a vicious circle.
WHO’s latest report:One-third of adults in the world suffer from hypertension, and 80% of them are out of control.
On August 25th, 2021, the Comprehensive Analysis Report on Global Hypertension Epidemic Trend, which was written by the World Health Organization (WHO) and Imperial College London, London, was published in The The Lancet, a well-known medical journal.
This report comprehensively reflects the global prevalence, diagnosis and treatment trend of hypertension so far. The report covers adult blood pressure measurement and treatment data in 184 countries around the world from 1990 to 2019, representing 99% of the global population.
Definition of hypertension:Systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or taking antihypertensive drugs.
Through the study of these massive data, it is found that in the past 30 years,About one-third of the adults in the world suffer from hypertension, and the number of hypertensive patients aged 30-79 has doubled.From 650 million people (331 million women and 317 million men) in 1990 to 1.28 billion people (626 million women and 652 million men) in 2019.
At the same time, the gap between diagnosis and treatment of hypertension is still significant. In 2019,There are about 580 million hypertensive patients (41% women, 51% men) in the world who have not been diagnosed and do not know that they have hypertension.,About 80% patients failed to control their blood pressure..More than half of hypertensive patientsAbout 720 million people (53% women and 62% men) did not get the necessary treatment.
China data:
From 1990 to 2019, the prevalence of male hypertension in China increased by 10%, ranking fifth among the 10 countries with the largest increase.
Although China ranked ninth among the 10 countries with the lowest prevalence of hypertension in 2019, the prevalence rate still reached 24%, which means that one in every four women aged 30-79 suffers from hypertension.
Specific dataAmong the population aged 30-79 in China, the prevalence rate of hypertension in women is 24.1%, the detection rate is 56.4%, and the treatment rate is 44.6%.The control rate is only 17.8%; The prevalence rate of male hypertension was 30.2%, the detection rate was 47.7%, and the treatment rate was 35.1%.The control rate is only 13.9%.
The report emphasizes that hypertension is directly related to the death of more than 8.5 million people worldwide every year and is the main risk factor for stroke, ischemic heart disease, other vascular diseases and kidney diseases.Controlling blood pressure can reduce stroke by 35%-40%, myocardial infarction by 20%-25% and heart failure by about 50%..
On the same day, the WHO Guidelines for Adult Hypertension Drug Treatment was released, which provided a series of recommendations based on the latest evidence to improve the global hypertension detection and management, including eight recommendations, including blood pressure level of initial treatment, drug selection and blood pressure monitoring target. We expect these suggestions to be effectively observed and help save more lives.
In addition, to effectively control blood pressure, there is another important factor-OSA cannot be ignored..OSA and hypertension can be mutually causal, forming a vicious circle.
Hypertension and OSA:A quarter of adults in China suffer from hypertension, and half of them have sleep apnea.
Hypertension is a key cardiovascular disease in China. According to the Healthy China Action (2019-2030), there are currently 270 million patients with hypertension in China, and the prevalence rate of hypertension among residents aged 18 and above is 25.2%. This means that one in every four people over the age of 18 suffers from high blood pressure. People’s blood pressure control is highly valued.
In some patients with poor blood pressure control,Sleep apnea is an important cause of intractable hypertension.Sleep apnea hypopnea syndrome (SAHS) characterized by frequent apnea and hypopnea can lead to or aggravate hypertension.SAHS and hypertension often occur together, which is an important cause of secondary hypertension.Clinically, most patients with SAHS belong to obstructive sleep apnea hypopnea syndrome (OSAHS)
OSAHS is one of the risk factors for hypertension independent of age, obesity and smoking.,50%~92% patients with OSAHS have hypertension.,However, 30%~50% of hypertensive patients are accompanied by OSAHS, and as high as 70% ~ 90% of refractory hypertensive patients are accompanied by OSAHS.. Hypertension associated with OSAHS is calledObstructive sleep apnea-associated hypertension is an independent risk factor for coronary heart disease, arrhythmia, stroke and other diseases, which can cause functional damage of multiple system organs.
How does OSAHS cause hypertension?
OSAHS leads to recurrent intermittent hypoxia, hypercapnia, nervous and humoral disorders and excessive excitement of the sympathetic nervous system, which can cause an increase in heart rate, myocardial contractility, cardiac output and systemic vascular resistance.Both are important causes of hypertension.
Among them,The most important thing is the enhancement of sympathetic nerve activity.It can increase the level of plasma catecholamine, increase the contraction of resistance arterioles and increase the resistance of peripheral blood vessels, resulting in hypertension.
Besides,Sleep structure disorderMechanical effects, oxidative stress and inflammation caused by the increase of negative pressure in the chest can also lead to hypertension.
How to identify OSHAS-related hypertension?
When blood pressure increases, you should be alert to sleep apnea if you have the following 10 situations:
(1) Obesity
(2) Abnormal anatomical structure of nasopharynx and maxillofacial region.
(3) Snoring during sleep, obvious drowsiness during the day, headache and dry mouth in the morning.
(4) Refractory hypertension or occult hypertension, hypertension in the morning, or hypertension with "non-dipper" or "inverted dipper" changes in blood pressure rhythm.
(5) Recurrent uncontrollable angina pectoris at night.
(6) Arrhythmia that is difficult to correct at night.
(7) Refractory congestive heart failure.
(8) Refractory and insulin resistance.
(9) Pulmonary hypertension of unknown cause.
(10) Unexplained nocturnal stagnation or nocturnal paroxysmal diseases.
How to screen OSHAS-related hypertension?
The National Basic Hypertension Prevention and Management Manual (2020 edition) points out that for patients with hypertension related to OSHAS, it is recommended to have a polysomnography (PSG) to make a definite diagnosis.
"Expert Consensus on Clinical Diagnosis and Treatment of Obstructive Sleep Apnea-related Hypertension" points out that patients with mild symptoms who lack PSG monitoring conditions or cannot be examined in the sleep monitoring room due to changes in sleep environment or too many leads can be preliminarily screened by portable screening instrument and followed up.
The research shows that UWB radar AHI and PSG AHI have excellent consistency. The high sensitivity and specificity of this technology can meet the ability of obstructive sleep apnea screening or dynamic monitoring at home, and it may be a portable, convenient and reliable device for screening patients suspected of obstructive sleep apnea.
References:
1. The World Health Organization official website "More than 700 million people suffer from untreated hypertension".
2. 2021-08-25 New medical viewpoint "One third of adults have hypertension, and 80% of them are out of control! Who recently released treatment guidelines, 8 recommended instructions! 》
3. Hypertension Committee of Chinese Medical Association, etc. Expert consensus on clinical diagnosis and treatment of obstructive sleep apnea-associated hypertension [J]. Journal of National Call and Critical Care, 2013,12(5):435-441
4. Carey RM, Calhoun DA, Bakris GL, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension (Dallas, Tex. : 1979). 2018 Nov; 72(5):e53-e90. DOI: 10.1161/hyp.0000000000000084. PMID: 30354828; PMCID: PMC6530990.
5. Zhou Yong, Shu Degui, et al. Verification of new automatic UWB radar in sleep apnea detection [J]. Journal of National Call and Critical Care, 2020,2: 1-10 DOI: 10.21037/JTD.2020.02.59.