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Factors Associated with Systemic Hypertension in Asthma

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Abstract

Purpose

Asthmatics have unique characteristics that may influence cardiovascular morbidity. We tested the association of lower airway caliber, obstructive sleep apnea (OSA), and other asthma-related factors, with systemic hypertension (HTN).

Methods

Asthma individuals at specialty clinics completed the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ). Medical records were reviewed for diagnosed HTN, OSA and comorbidities, spirometry, and current medications. FEV1% predicted was categorized as ≥80 (reference), 70–79, 60–69, and <60. SA-SDQ ≥36 for men and ≥32 for women defined high OSA risk.

Results

Among 812 asthmatics (mean age ± standard deviation: 46 ± 14 years), HTN was diagnosed in 191 (24 %), OSA in 65 (8 %), and OSA or high OSA risk (combined OSA variable) in 239 (29 %). HTN was more prevalent in lower FEV1% categories (p < 0.0001), in subjects with OSA, and those with combined OSA variable (55 vs. 21 % and 46 vs. 14 %, respectively, both p < 0.0001). With adjustment for covariates, associations with HTN remained significant for some FEV1% categories (70–79 % odds ratio = 1.60 [95 % CI 0.90–2.87]; 60–69 % 2.73 [1.28–5.79]; <60 % 0.96 [0.43–2.14]), and for OSA (2.20 [1.16–4.19]). The combined OSA variable in comparison with OSA alone demonstrated a stronger association with HTN (3.17 [1.99–5.04]) in a reiteration of this model. Inhaled corticosteroids (ICS) at lowest doses, in comparison to no ICS use had an independent “protective” association with HTN (0.44 [0.22–0.90]).

Conclusions

In this young population, worse lower airways obstruction and OSA were associated with HTN. In contrast, lower ICS doses attenuated likelihood for HTN. Adequate control of airway inflammation at appropriate ICS doses, and screening for OSA may reduce the burden of HTN in asthma.

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Abbreviations

AHI:

Apnea–hypopnea index

BMI:

Body mass index (in kilograms per meter squared)

CI:

Confidence interval

CPAP:

Continuous positive airway pressure

COPD:

Chronic obstructive pulmonary disease

CRP:

C-reactive protein

FEF25–75 :

Forced expiratory flow between 25 and 75 % of vital capacity

FEV1 :

Forced expiratory volume in first second of the vital capacity

FVC:

Forced vital capacity

GERD:

Gastroesophageal reflux disease

HTN:

Systemic hypertension

IH:

Intermittent hypoxia related to obstructive sleep apnea

ICS:

Inhaled corticosteroid

LABA:

Long acting β2-Agonist

LTM:

Leukotriene modifiers

NAEPP:

National asthma education and prevention program

NHANES:

National health and nutrition examination survey

OR:

Odds ratio

OSA:

Obstructive sleep apnea

PEFR:

Peak expiratory flow rate

PSG:

Polysomnography (laboratory-based sleep study)

SA-SDQ:

Sleep Apnea scale of the Sleep Disorders Questionnaire

SD:

Standard deviation of the mean

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Acknowledgments

The authors are grateful to the study subjects at both institutions, for their participation. As well, to student assistants for administering the questionnaires in clinics, and for data entry. We recognize the help from the providers and staff at the Pulmonary Clinics and Briarwood Asthma-Airways Center at the University of Michigan-Ann Arbor, and Allergy and Pulmonary Clinics at the University of Wisconsin-Madison in recruiting subjects for this study. This study was funded by the University of Michigan General Clinical Research Center (MO1 RR00042) and Neurology Department Training Grant 5T32NS007222; University of Wisconsin School of Medicine and Public Health, Department of Medicine, and Medical Education and Research Committee - New Investigator Award; 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health; and additional resources from William S. Middleton Memorial VA Hospital, Madison, Wisconsin.

Conflict of interest

Drs. S Ferguson, RE Gangnon, FB Consens, MC Teodorescu, and Ms. AG Peterson have no relationships to disclose. Dr. Mihaela Teodorescu received funding from the University of Wisconsin School of Medicine and Public Health, Department of Medicine and Medical Education and Research Committee-New Investigator Award, and National Institutes of Health, National Center for Research Resources (MO1 RR00042 and 1UL1RR025011 Clinical and Translational Science Award [CTSA] program), for asthma-sleep apnea research. Dr. RD Chervin has received research support from the National Institutes of Health and Fox Foundation; has served on advisory boards for Pavad Medical, not-for-profit Sweet Dreamzzz, and the NHLBI (Sleep Disorders Research Advisory Board); is a section editor for UpToDate, Inc.; received support for educational purposes from Philips Respironics, Inc. and Fisher Paykel, Inc.; has consulted for Arena Pharmaceuticals, Proctor & Gamble, and Zansors; serves on boards of directors for the American Academy of Sleep Medicine and the International Pediatric Sleep Association; and is named in University of Michigan patents for algorithms and devices to facilitate diagnosis and treatment of sleep disorders. The content of this article is solely the responsibility of the authors and does not represent the views of the US Department of Veterans Affairs, NIH or the United States Government.

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Authors and Affiliations

  1. James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial VA Hospital, Madison, WI, USA

    Susan Ferguson, Mihai C. Teodorescu & Mihaela Teodorescu

  2. Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, K4/910 CSC 9988, 600 Highland Avenue, Madison, WI, 53792-9988, USA

    Susan Ferguson, Andrea G. Peterson & Mihaela Teodorescu

  3. Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Mihai C. Teodorescu & Mihaela Teodorescu

  4. Section of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Mihai C. Teodorescu

  5. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ronald E. Gangnon

  6. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ronald E. Gangnon

  7. Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI, USA

    Flavia B. Consens & Ronald D. Chervin

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  1. Susan Ferguson
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  2. Mihai C. Teodorescu
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Correspondence to Mihaela Teodorescu.

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Ferguson, S., Teodorescu, M.C., Gangnon, R.E. et al. Factors Associated with Systemic Hypertension in Asthma. Lung 192, 675–683 (2014). https://doi.org/10.1007/s00408-014-9600-y

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