MD Conference Express ATS 2013 - (Page 21)
clinically reduced following treatment with continuous to the CPAP arm. Moreover there was a positive and linear
positive airway pressure (CPAP). In those patients with relationship between the number of hours of CPAP use
good adherence to CPAP therapy, a significant percentage and the decrease in 24-hour BP values, both BP diurnal
recovered their normal nocturnal dipper pattern and/ and nocturnal values. The presence or absence of daytime
or reversed their riser pattern. Miguel Ángel Martínez- hypersomnolence, sex, age, years from RH diagnosis and
García, MD, PhD, University and Polytechnic La Fe BMI had no impact on treatment effectiveness.
Hospital, Valencia, Spain, presented the results of the
Prof. Martínez-García would like to see future long-term
HIPARCO study (Hipertensión Arterial Resistente Control studies that analyze the effect of CPAP on the incidence of
con CPAP).
CV events or death and BP treatment in these patients with
The objective of this multicenter study was to evaluate RH and OSA.
the effect of CPAP treatment on the BP levels and nocturnal
BP pattern in patients with OSA and RH. Patients with RH and
confirmed OSA were randomly assigned to usual medical Effects of Obesity on COPD
therapy (n=96) or medical therapy plus tritated fixed CPAP Written by Lori Alexander
pressure (n=98) for 12 weeks. Patients with 24-hour BP
>130/85 mm Hg (determined by ambulatory blood pressure The impact of obesity on many chronic diseases is well
monitoring [ABPM]), an apnea-hypopnea index >15, and with known, but the effect of obesity on clinical outcomes
at least an 80% adherence to antihypertensive drug treatment for people with chronic obstructive pulmonary disease
were included in the study. The prevalence of OSA was 82.7% (COPD) is less clear. The number of people with COPD
in this population. Patients were monitored at 2, 4, 8, and who are obese is expected to increase in line with the
12 weeks for CPAP and antihypertensive drug adherence, obesity pandemic, making it essential to gain a better
changes in body mass index (BMI), and new cardiovascular understanding of the effects of obesity on COPD.
(CV) events. At the 12-week visit, patients underwent a second
Although classically considered a wasting disease, a
24-hour ABPM. All randomized patients independent of their link between COPD and obesity is becoming increasingly
use or not of CPAP were included in the intention-to-treat recognized, and it may influence clinical diversity in COPD,
(ITT) analysis and those patients with a good
said Frits M. E. Franssen, MD, PhD, CIRO+,
adherence to CPAP ( ≥4 hours of CPAP; 68% of
Center of Expertise for Chronic Organ Failure,
randomized patients) use were included in the
Horn, The Netherlands. Data on the prevalence
Increasing
evidence suggests
per protocol (PP) analysis.
of obesity in COPD have conflicted, with some
a relationship
Demographics and baseline characteristics
studies showing a higher prevalence among
between visceral
were similar in both treatment groups. Mean
patients with COPD and others showing a
adipose tissue
BMI was 34.1±5.4 kg/m2; mean number of
lower prevalence [Vozoris NT, O’Donnell
dysfunction and the
antihypertensive drug used was 3.8±0.9; 21.4%
DE. Can Respir J 2012; Montes de Oca M et
pathophysiology of
COPD.
of participants had past CV events; mean 24al. Respir Med 2008; Steuten LM et al. Prim
hour BP was 144.2±12.5/83.0±10.5 mm Hg. More
Care Respir J 2006; Eisner MD et al. Respir Res
than 70% of patients had a nondipper (42.8%)
2007]. Low levels of physical activity have been
or a riser nocturnal (31.4%) BP pattern. Almost 95% of the consistently reported for patients with COPD, and this may
patients were on diuretics.
contribute to weight gain.
In the ITT analysis, the use of CPAP significantly reduced
Contrary to expectations, obesity is not necessarily
diastolic (p=0.005) and mean BP (p=0.016) compared with associated with worse patient-related outcomes in COPD,
the control group and was associated with a near-significant said Prof. Franssen. He pointed to an early study in which
reduction in 24-hour systolic BP (p=0.09). The reductions the risk of mortality was evaluated in obese and normal(about 3 mm Hg), were clinically relevant. In the PP weight patients with COPD [Landbo C et al. Am J Respir
analysis (only those patients with good CPAP compliance), Crit Care Med 1999]. The relative risk of all-cause mortality
CPAP use significantly decreased systolic BP, diastolic was increased for obese patients with mild or moderate
BP, and mean BP by 4 to 5 mm Hg (p=0.01, p=0.001, and COPD compared with normal-weight patients. However,
p=0.001, respectively).
in contrast to patients with mild and moderate COPD,
The decreases in BP levels were more pronounced among patients with severe disease, the risks of all-cause
during the night especially in those patients with better and COPD-related mortality were lowest for obese patients.
tolerance to CPAP.
These findings are referred to as the obesity paradox.
The probability of recovering the dipper pattern and
Studies have also found different effects of obesity on
reversing the riser pattern was significantly greater (p≤0.03) dyspnea. In one study, obese patients with COPD reported
in both the ITT and PP analysis in those patients allocated increased dyspnea and poorer health-related quality of life
Official Peer-Reviewed Highlights From the American Thoracic Society International Conference 2013
21
Table of Contents for the Digital Edition of MD Conference Express ATS 2013
MD Conference Express ATS 2013
Contents
Prevention and Early Treatment of Acute Lung Injury
Nocturnal Noninvasive Ventilation Improves Outcomes in Multiple Disorders
Hospital Readmissions: Challenges and Opportunities
EBUS-TBNA: Accurate and Safe for Detecting Sarcoidosis
Data Link Obstructive Sleep Apnea and Type 2 Diabetes
Statin Use Improves Respiratory-Related Mortality in Patients With COPD
Addition of Spironolactone to Ambrisentan May Be a Novel Treatment Strategy to Improve Outcome in Patients With PAH
Haloperidol Does Not Prevent Delirium in Ventilated ICU Patients
Beraprost Plus Sildenafil Effective in Pulmonary Arterial Hypertension
Dupilumab Is Safe and Effective for Controlling Asthma Attacks
Once-Daily QVA149 Improves Breathlessness in COPD Patients
CPAP in CVD and OSA Does Not Significantly Improve Cardiovascular Biomarkers
CPAP Reduces BP in Patients With Resistant Hypertension and Obstructive Sleep Apnea
Effects of Obesity on COPD
Pulmonary Embolism
Ventilator-Associated Pneumonia
Lung Cancer Screening
Idiopathic Pulmonary Fibrosis
Non-Small-Cell Lung Cancer
MD Conference Express ATS 2013
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