Long-term effect of obstructive sleep apnoea management on blood pressure in patients with resistant hypertension: the SARAH study.

BACKGROUND: There is a close relationship between obstructive sleep apnoea (OSA) and resistant hypertension (RH). However, studies assessing the long-term effect of diagnosing and treating OSA on blood pressure (BP) control in these patients are lacking. METHODS: To address this gap, we recruited 478 RH patients from hypertension units and followed them prospectively after they were screened for OSA through a sleep study. By performing 24-h ambulatory BP monitoring (ABPM) annually, the effect of OSA management was assessed. RESULTS: The patients had a median (interquartile range (IQR)) age of 64.0 (57.2-69.0) years, 67% were males and most were nonsleepy, with a median (IQR) apnoea-hypopnoea index (AHI) of 15.8 (7.9-30.7) events·h-1. The median (IQR) follow-up time was 3.01 (2.93-3.12) years. At baseline, severe OSA was associated with uncontrolled BP, nocturnal hypertension and a nondipper circadian BP pattern. Moreover, these patients had higher BP values during follow-up than did patients in the other groups. However, among patients with moderate and severe OSA, the management of sleep disordered breathing, including the implementation of continuous positive airway pressure treatment, was associated with a reduction in 24-h ABPM parameters, especially night-time BP values, at the 1-year follow-up. These benefits were attenuated over time and only subjects with severe OSA maintained an ABPM night-time reduction at 3 years. Furthermore, clinical variables such as uncontrolled BP, sex and age showed a predictive value for the BP response at 1 year of follow-up. CONCLUSION: A favourable long-term decrease in BP was detected by diagnosing and treating OSA in a cohort of RH patients from hypertension units, but over time this decrease was only partially maintained in severe OSA patients.

Clinical characteristics of complete responders versus non-complete responders to omalizumab, benralizumab and mepolizumab in patients with severe asthma: a long-term retrospective analysis.

BACKGROUND: Some patients with severe asthma may benefit from treatment with biologics, but evidence has been mostly collected from randomized controlled trials (RCTs), in which patients' characteristics are different from those encountered in asthma patients in the real-world setting. The aim of this study was to describe the clinical features of complete responders versus non-complete responders to long-term treatment with biologics in patients with severe asthma attended in routine daily practice. METHODS: Data of a cohort of 90 patients with severe asthma who were treated with biologics (omalizumab, benralizumab, and mepolizumab) for at least 12 months and were followed up to March 2022. Data recorded included clinical characteristics and effectiveness of treatment (exacerbation, Asthma Control Test [ACT] score, lung function, use of maintenance oral corticosteroids [mOCS]), FeNO, and blood eosinophils at baseline, at 12 months, and at the end of follow-up. Complete response is considered if, in addition to not presenting exacerbations or the use of mOCS, the ACT score was >20 and, the FEV1 >80% predicted. RESULTS: An improvement in all asthma control parameters was observed after 12 months of treatment and a mean follow-up of 55 months. After 12 months of treatment 27.2% of patients met the criteria of complete response and this percentage even increased to 35.3% at the end of follow-up. Long-term complete response was associated to better lung function with mepolizumab and omalizumab treatment and to less previous exacerbations in the benralizumab group. The main cause of not achieving a complete response was the persistence of an airflow obstructive pattern. CONCLUSIONS: This study shows that omalizumab, benralizumab, and mepolizumab improved the clinical outcomes of patients with severe asthma in a clinic environment with similar effect sizes to RCTs in the long term follow-up. Airflow obstruction, however, was a predictor of a non-complete response to biologics.

Treatment with anti-IgE and anti-IL-5 biologics significantly improved clinical outcomes in severe asthma patients.The rate of complete responders of 27.2% at 12 months even increased to 35.3% at the end of a mean follow-up of 55 months.The persistence of an airflow obstructive pattern was the main cause of the failure to achieve complete response.

Alcohol y tabaco en adolescentes españoles y mexicanos y su relación con la actividad físico-deportiva y la familia / Alcohol and tobacco consumption in Spanish and Mexican adolescents and its relation to physical and sports-related activity and to the family

OBJETIVO: Identificar la influencia del consumo de alcohol o tabaco junto a variables independientes (sexo y edad; tiempo y actividades de ocio; motivaciones, patrones, modalidades y finalidades físico-deportivas; y conductas del entorno familiar) en la actividad físico-deportiva de alumnos de educación secundaria obligatoria en España y México. MÉTODOS: 3 249 alumnos españoles y 1 083 alumnos mexicanos de entre 12 y 16 años respondieron un cuestionario sobre hábitos físico-deportivos, consumo de bebidas alcohólicas o tabaco e influencia del entorno familiar. Se realizó un análisis descriptivo y una regresión logística multinomial para averiguar la capacidad predictiva de las variables incluidas en el modelo. RESULTADOS: En ambos países el consumo aumenta con la edad. Comparativamente existe mayor prevalencia entre los estudiantes españoles a la hora de consumir sustancias adictivas. Los estudiantes españoles físicamente activos tienen menos probabilidades de consumir alcohol y tabaco; entre los mexicanos no se encuentran diferencias significativas al respecto. Los resultados reflejan que en España las mujeres consumen bebidas alcohólicas y fuman con mayor frecuencia. Los varones españoles, sin embargo, lo hacen de manera esporádica pero en mayores cantidades. En México, los adolescentes consumen alcohol más regularmente que las adolescentes, pero no existen diferencias en la cantidad. CONCLUSIONES: En España, la práctica de actividades físico-deportivas se relaciona claramente con un menor consumo. Ser físicamente activo actúa como agente protector ante hábitos no saludables. En los adolescentes mexicanos no se ha encontrado una relación significativa entre estos factores. Tanto en España como en México, los hermanos y los padres son los familiares que mayor influencia ejercen respecto del consumo de alcohol y tabaco. Además, se ha comprobado la tendencia a un consumo simultáneo de ambas sustancias.

OBJECTIVE: To identify the influence of alcohol or tobacco consumption along with independent variables (sex and age; time and leisure activities; motivations, patterns, modalities, and goals of physical and sports-related activity; and behaviors within the family environment) in physical and sports-related activity among pupils enrolled in compulsory secondary education in Spain and Mexico. METHODS: A questionnaire on habits related to physical and sports-related activity, consumption of alcoholic beverages or tobacco, and the influence of the family environment was answered by 3 249 Spanish pupils and 1 083 Mexican pupils between 12 and 16 years of age. A descriptive analysis and a multinomial logistic regression were carried out in order to ascertain the predictive capacity of the variables included in the model. RESULTS: In both countries, consumption increases with age. In comparative terms, there is a higher prevalence among Spanish pupils when consuming addictive substances. The Spanish pupils who are physically active are less likely to consume alcohol and tobacco; among their Mexican counterparts, there were no significant differences in this regard. The results show that in Spain, females consume alcoholic beverages and smoke more frequently than do males, who do so sporadically but in greater quantities. In Mexico, adolescent boys consume alcohol more regularly that do adolescent girls, although there are no differences in terms of quantity. CONCLUSIONS: In Spain, being physically active and engaging in sports is clearly related to consuming less. Being physically active acts as a protective agent against unhealthy habits. Among Mexican adolescents, no significant relationship between these factors has been found. Both in Spain and in Mexico, siblings and parents are the family members who have the greatest influence vis-à-vis alcohol and tobacco consumption. Furthermore, the trend towards simultaneous consumption of both substances...