This project aims to implement a new hypertension management system, which will include
the monitoring and treatment of respiratory disorders during sleep. This new precision
medicine-based management will be carried out in the Primary Care setting and will
improve blood pressure control, the main risk factor for the leading cause of death
worldwide: cardiovascular diseases.
The current model for managing patients with essential hypertension is based on deciding
when to treat with measures that go beyond dietary and lifestyle interventions. Once it
is decided to treat the patient pharmacologically, the ideal drug is decided and during
follow-up whether it is necessary to change the treatment or not. This entire process is
usually carried out by the Primary Care doctors. The hypertension specialist is usually
reserved for difficult-to-control cases or patients with resistant hypertension. In the
current model there is little communication between the different levels of care. In
addition, the study of the SDB is carried out completely independently of this process.
The METASLEEP project aims to change this work dynamic. The creation of the METASLEEP
PC-node centralizes care for patients with hypertension in the Primary Care team
(physician and nurse). The PC-node will evaluate the patient comprehensively,
incorporating 24-hour ambulatory blood pressure monitoring as well as a sleep study.
There will be coordination with the hypertension specialist for the management of complex
cases and with the sleep unit specialist to support therapeutic decisions or management
of patients with complex sleep apnea. Moreover, our project aims to incorporate the
precision medicine techniques, such as the HIPARCO-score in the clinical management of
hypertensive patients. Furthermore, the investigators aim to identify the best option
that guarantees the best control in different clinical situations, with the greatest
anticipation and with the fewest side effects, as well as with the greatest additional
benefits and, finally, when to modify the treatment.
The METASLEEP project aims to contribute to the development of personalized medicine
tools by identifying the molecular profile that enables to develop a non-invasive model
with clinical utility. This model will contribute to the characterization of the patient
that is vulnerable to the deleterious effects of OSA and who would benefit from OSA
treatment to improve cardiovascular morbidity. The availability of an instrument based on
a biomarker profile for risk stratification will help the physician to make therapeutic
decisions in individuals with OSA and hypertension, contributing to the change of the
current clinical management guidelines. Likewise, molecular tools can be developed to
identify the profile of the patient that positively respond to CPAP treatment (in terms
of blood pressure decrease). Finally, the investigators will obtain data that will
evaluate the economic impact of the METASLEEP project. This cost-effectiveness analysis
will be carried out from the perspectives of both, the SNS and the social perspective.
Importantly, the investigators have planned a specific objective to define and calculate
quantitatively, qualitative and cost-effectively the METASLEEP project, compared to the
conventional current procedure.
The overall objective of the METASLEEP project is to establish a new paradigm in the
treatment of hypertension through the management of sleep disordered breathing (SDB).
The specific objectives, are the following:
To implement the management of hypertension based on the presence of nocturnal
hypertension and SDB (METASLEEP model).
To depict a singular cluster of circulating miRNAs (METASLEEP-score) in patients
with nocturnal hypertension and SDB.
To characterize highly responder patients that would benefit from SDB treatment in
terms of blood pressure control.
To implement in the clinical practice the use of the HIPARCO-score technology for
the management of resistant hypertension.
To evaluate the feasibility and acceptability of the METASLEEP model for the
comprehensive clinical management of hypertension based in the management of SDB.