Reflux Episodes Spike BP in People With GERD and Hypertension
In patients with both gastroesophageal reflux disease (GERD) and essential hypertension, episodes of reflux can trigger elevations in blood pressure (BP), especially at night, according to research from China.
Short-term antacid therapy using the proton-pump inhibitor omeprazole also significantly reduced multiple measures of both reflux and BP, in an uncontrolled comparison.
“This study demonstrated that parts of reflux episodes might be associated with BP elevation. When GERD and essential hypertension coexist, treatment of GERD could be useful for normalizing BP,” corresponding author Dr. Zhong-gao Wang, of the First Affiliated Hospital of Zhengzhou University, Henan Province, China, told Reuters Health by email.
The study was published online October 4 in the Journal of Clinical Gastroenterology.
The researchers had 86 people (mean age, 53) with essential hypertension undergo initial 24-hour BP monitoring, as well as esophageal impedance and pH monitoring. All participants were asked to stop any form of antacid therapy for at least 2 weeks before the study, but antihypertensive therapy was not altered.
Hypertension provoked by GERD was defined as elevation of systolic BP to at least 140 mmHg, and/or diastolic BP to at least 90 mmHg, during and for up to 10 minutes after an episode of pathologic reflux (PR was defined as a fall in esophageal pH to <4 for more than 5 minutes).
The 24-hour monitoring identified GERD in 38 participants; the other 48 did not have GERD. Esophagitis was more common in patients with GERD than in those without GERD, as was the incidence of high BP episodes.
All 38 participants with GERD experienced episodes of high BP during the 24-hour monitoring. In all, they had 494 PR episodes and 684 episodes of high BP (15% of the hypertensive episodes were synchronous with PR). Of the 38 GERD participants, 24 had at least one episode of high BP that depended on PR occurrence. PR was more common at night than during the day.
These 24 patients were then given a 14-day course of twice-daily 20-mg omeprazole. At the end of the treatment course, they underwent a second 24 hours of monitoring. Omeprazole therapy was found to have significantly reduced the mean composite pH score, number of PR episodes (from 28 to 9), and BP (by roughly 7 mmHg systolic and 5 mmHg diastolic).
The authors write that their study “demonstrated that parts of reflux episodes might be associated with BP elevation. Antacid therapy restored esophageal pH to normal and significantly lowered elevated BP, which suggested that treatment of GERD could be useful for normalizing BP in essential hypertension patients.”
The authors found a “modest association” between episodes of gastrointestinal acid production and BP at night, when people are supine and tend to produce more acid and have a greater likelihood of acid reflux, according to Dr. William B. White of the University of Connecticut Health Center, who was not involved in the study.
He added that BP normally goes down at night and is very stable during sleep, so small changes can be observed more easily.
Dr. White called the article “descriptive” and “hypothesis-generating,” given its small size and lack of a control group for the omeprazole treatment phase. He nevertheless concluded that “the observation has the possibility of being real.”
J Clin Gastroenterol 2017.
By Scott Baltic
October 19, 2017
Reuters Health Information © 2017
