Te Tue T, Fung Constance H, Boland Mary Regina
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Geriatric, Research, Education and Clinical Center, VA Greater Los Angeles, Los Angeles, CA, USA.
Clin Hypertens. 2025 Jan 2;31:e2. doi: 10.5646/ch.2025.31.e2. eCollection 2025.
Our study investigates the temporality of factors that modulate the risk for developing hypertension (HTN) among patients with obstructive sleep apnea (OSA) without preexisting HTN at baseline.
Our cohort consisted of OSA cases (based on International Classification of Diseases, 9th/10th Revision) with 20 common comorbidities selected using a previously validated electronic health record (EHR)-based algorithm. We constructed a survival model to estimate time-to-first HTN diagnosis (among patients with OSA without preexisting HTN). Our survival model included those comorbidities along with sex, body mass index, race, and age. We also performed a validation of the date of diagnosis of OSA and HTN identified from our algorithm by utilizing chart reviews in 400 randomly chosen EHR-defined cases.
Among 53,035 OSA cases diagnosed between 2012 and 2021, 31,741 cases (59.8%) were without preexisting HTN at the date of OSA diagnosis and thus met our inclusion criteria. Within our survival cohort, 15,830 OSA cases (50.1%) did not develop HTN. Cardiovascular conditions (including atrial fibrillation, coronary atherosclerosis, hypercholesterolemia, diabetes), tobacco use, anemia, osteoarthrosis, and gastroesophageal reflux disease were observed to increase risk of incident HTN. Allergic rhinitis, fatigue, joint pain, and vitamin D deficiency did not increase risk of incident HTN. Chart review demonstrated diagnoses of OSA and HTN were documented in notes a median of 38 days and 738 days, respectively, prior to being coded in the EHR.
In a large EHR sample, we identified conditions that are associated with increased risk of incident HTN among patients diagnosed with OSA. These findings may help guide counseling efforts among patients newly diagnosed with OSA regarding factors that may modulate risk for developing HTN.
我们的研究调查了在基线时无高血压（HTN）的阻塞性睡眠呼吸暂停（OSA）患者中，调节患高血压风险的因素的时间性。
我们的队列由OSA病例（基于国际疾病分类第9/10版）组成，这些病例伴有20种常见的合并症，通过先前验证的基于电子健康记录（EHR）的算法进行选择。我们构建了一个生存模型来估计首次诊断为HTN的时间（在无既往HTN的OSA患者中）。我们的生存模型包括这些合并症以及性别、体重指数、种族和年龄。我们还通过对400例随机选择的EHR定义病例进行图表回顾，对从我们的算法中确定的OSA和HTN诊断日期进行了验证。
在2012年至2021年期间诊断的53,035例OSA病例中，31,741例（59.8%）在OSA诊断时无既往HTN，因此符合我们的纳入标准。在我们的生存队列中，15,830例OSA病例（50.1%）未患HTN。观察到心血管疾病（包括心房颤动、冠状动脉粥样硬化、高胆固醇血症、糖尿病）、吸烟、贫血、骨关节炎和胃食管反流病会增加新发HTN的风险。过敏性鼻炎、疲劳、关节痛和维生素D缺乏不会增加新发HTN的风险。图表回顾显示，OSA和HTN的诊断在EHR编码之前，分别在病历中记录的中位数时间为38天和738天。
在一个大型EHR样本中，我们确定了与诊断为OSA的患者新发HTN风险增加相关的情况。这些发现可能有助于指导新诊断为OSA的患者就可能调节患HTN风险的因素进行咨询。
