Infraestructura de Medicina de Precisión asociada a la Ciencia y la Tecnología
METASLEEP aims to revolutionize hypertension management, innovatively integrating the monitoring and treatment of breathing disorders during sleep. This approach stems from the finding that, according to the International Consensus Document on Obstructive Sleep Apnea (OSA) published in 2022, 30% of patients diagnosed with hypertension also suffer from OSA. This prevalence is even higher in those patients who present a non-dipper circadian pattern of blood pressure (BP), characterized by a lack of nocturnal decrease in BP. Faced with this reality, METASLEEP aims to incorporate the diagnosis and treatment of OSA into the primary care routine, with the hope of significantly improving the clinical outcomes of these patients.
The current management of essential hypertension is based on dietary, lifestyle and pharmacological interventions, with a diagnosis starting at 140/90 mmHg and a control goal below 130/80 mmHg, with outpatient or self-measured BP monitoring being important outside the clinic. This process is mainly managed by primary care physicians, reserving the hypertension specialist for cases that are difficult to control or patients with resistant hypertension. However, there is little communication between the different levels of care, and sleep studies are not contemplated despite the high prevalence of OSA in hypertensive patients.
The creation of the AP-METASLEEP node centralises the care of hypertensive patients in the Primary Care care team (doctor and nurse). This node will be responsible for performing a comprehensive evaluation of the patient, which will include ambulatory blood pressure monitoring (ABPM) for 24 hours on a routine basis. In those cases in which nocturnal hypertension and/or a non-dipper pattern is detected, a sleep study will be carried out using ambulatory respiratory polygraphy. This methodology will allow patients with OSA to be identified early, thus facilitating their timely treatment. Coordination between the different levels of care will be a fundamental pillar of the project. There will be close collaboration with hypertension specialists for the management of complex cases and with sleep disorder specialists to support therapeutic decisions. This interdisciplinary collaboration will ensure that patients receive the most appropriate treatment at each stage of their disease, thus optimizing clinical outcomes.
METASLEEP also seeks to optimize the treatment of hypertension through personalized medicine tools that identify specific molecular profiles, helping to characterize the patients most vulnerable to OSA, or who best respond to its treatment, and improving their cardiovascular morbidity. The project will develop an instrument based on biomarkers for risk stratification, helping the clinician in decision-making and with the potential to impact clinical guidelines. Patients in whom OSA treatment is particularly beneficial in terms of BP reduction will also be identified. Finally, a cost-effectiveness analysis will be carried out from the perspective of the National Health System and the social one, evaluating the possible economic benefits of the new management model.
In summary, the METASLEEP project represents an innovative and precision medicine-based approach to the management of hypertension in the primary care setting. By integrating the detection and treatment of sleep-disordered breathing, it is hoped to significantly improve blood pressure control, thereby reducing the risk of cardiovascular disease, which is the leading cause of death globally.
General objective:
To establish a new paradigm in the treatment of hypertension through the management of sleep-disordered breathing (SDB).
Specific objectives:
The METASLEEP project represents a crucial advance in the management of hypertension, focusing on the relationship between sleep-disordered breathing and cardiovascular disease. With more than 20 years of research and the support of the Spanish Sleep Network, this team of experts has been key in demonstrating that the management of sleep-disordered breathing can be an effective strategy to control hypertension.
The impact of the project lies in its potential to change the current paradigms of hypertension treatment, by introducing new management opportunities based on the characterization of nocturnal hypertension (or non-dipper pattern), diagnosis and treatment of OSA, the development of personalized medicine and the use of molecular technology. All this, managed from primary care.