The Role of Gastroesophageal Reflux in Provoking High Blood Pressure Episodes in Patients With Hypertension

Abstract

Goals: We assessed the relationship between gastroesophageal reflux disease (GERD) and hypertension and whether antiacid therapy could be used to control blood pressure (BP) on hypertension in patients with GERD.

Background: Gastroesophageal reflux disease (GERD) may provoke cardiovascular disease. Many factors are involved in the development of essential hypertension, but whether GERD has a role needs further study.

Study: Patients with essential hypertension (n=86) were studied by 24-hour continuous BP monitoring and esophageal impedance and pH monitoring. Patients fulfilling the GERD criteria received 14-day therapy with omeprazole (20 mg twice a day), and the effect on BP was studied.

Results: Of the 86 essential hypertension patients, 38 (44.2%) had GERD. Among these 38 patients, 494 episodes of pathologic reflux (PR), and 684 episodes of high BP were recorded. PR was significantly more common at nighttime especially when supine. Of the 684 episodes of hypertension, 102 (14.9%) were synchronous with PR. GERD patients had significantly higher nocturnal BP than non-GERD patients. Antiacid therapy brought about significant reduction in all esophageal monitoring parameters as well as in BP parameters in GERD patients.

Conclusions: This study demonstrated that there is significant correlation between hypertension and GERD. Antiacid therapy can restore normal esophageal pH and help maintain normal BP.

FIGURE 1

Selection of the study group based on the results of concurrent 24-hour BP and esophageal pH monitoring. GERD indicates gastroesophageal reflux disease; BP, blood pressure; HE, high BP episodes; HE dependent on PR, high BP episodes, with at least 1-episode dependent on pathologic reflux.

FIGURE 2

Scatter plot of reflux episodes and high BP episodes among 38 GERD patients during the monitoring period (nonlinear regression analyses, R²=0.259; x-axis stands for a 24-hour monitoring period, y-axis stands for episodes of 2 variables). GERD indicates gastroesophageal reflux disease; BP, blood pressure; HP, hypertension.

FIGURE 3

GERD patients have significantly higher nocturnal BP than non-GERD patients (systolic BP, P=0.026; diastolic BP, P=0.020). *Significant difference between bars in the same cluster (P<0.05). GERD indicates gastroesophageal reflux disease; BP, blood pressure; NS, not significant.

FIGURE 4

Blood pressure in 24 GERD patients before antiacid treatment and at the 14-day follow-up. GERD indicates gastroesophageal reflux disease; TSBP, mean systolic blood pressure; TDBP, mean diastolic blood pressure; DSBP, mean daytime systolic blood pressure; DDBP, mean daytime diastolic blood pressure; NSBP, mean nocturnal systolic blood pressure; NDBP, mean nocturnal diastolic blood pressure. *Significant difference between bars in the same cluster (P<0.05).