title: Factors associated with systemic hypertension in asthma.
abstract: OBJECTIVE
  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.
authors.affiliation: James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial VA Hospital, Madison, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Ferguson
authors.forename: Mihai C
authors.initials: MC
authors.lastname: Teodorescu
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Gangnon
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Peterson
authors.forename: Flavia B
authors.initials: FB
authors.lastname: Consens
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.forename: Mihaela
authors.initials: M
authors.lastname: Teodorescu
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D065840:Protective Factors; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013147:Spirometry; D011795:Surveys and Questionnaires; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones