Rationale and Methodology of the SARAH Trial: Long-Term Cardiovascular Outcomes in Patients With Resistant Hypertension and Obstructive Sleep Apnea

Arch Bronconeumol (Engl Ed). 2018 Oct;54(10):518-523. doi: 10.1016/j.arbres.2018.03.002. Epub 2018 May 23.
[Article in English, Spanish]

Abstract

Introduction: Patients with resistant hypertension (RH) have a high risk of developing cardiovascular events; therefore, new therapeutic approaches to better control blood pressure may be useful in improving cardiovascular outcomes. The prevalence of obstructive sleep apnea (OSA) is very high among patients with RH. Continuous positive airway pressure (CPAP) has been shown to be an effective treatment for reducing blood pressure in patients with RH. Nevertheless, the long-term effect of CPAP treatment on cardiovascular outcomes has not been explored. The main objective of the SARAH study is to assess the impact of OSA and its treatment on cardiovascular outcomes (morbidity and mortality) in patients with RH.

Methods: This study is a multi-center, prospective, observational cohort study. A total of 1371 patients with RH will be enrolled in the study and followed once a year for five years. At inclusion, ambulatory blood pressure monitoring (ABPM) and a sleep study will be performed in all subjects. Socio-demographic, clinical and cardiovascular variables will be collected at baseline and follow-up. Subsequently, subjects with OSA will be managed according to local standard practice. Based on the OSA diagnosis and its treatment, three cohorts of subjects with RH will be defined: non-OSA, treated OSA and non-treated OSA.

Conclusions: This study will contribute to elucidating the long-term impact of OSA treatments on blood pressure control and cardiovascular outcomes in patients with RH. These results will contribute to improve the cardiovascular prognosis of patients with RH.

Keywords: Ambulatory blood pressure monitoring; Apnea del sueño; Continuous positive airway pressure; Hipertensión resistente; Monitorización ambulatoria de la presión arterial; Presión positiva continua de las vías respiratorias; Resistant hypertension; Sleep apnea.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Coronary Vasospasm / complications
  • Coronary Vasospasm / therapy*
  • Humans
  • Hypertension / complications
  • Hypertension / therapy*
  • Prospective Studies
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / therapy*
  • Time Factors
  • Treatment Outcome

Supplementary concepts

  • Hypertension Resistant to Conventional Therapy