Cristina Navarro-Soriano1, Gerard Torres2, Ferrán Barbé3,4, Manuel Sánchez-de-la-Torre5,4, Pedro Mañas6,4, Patricia Lloberes7,4, Trinidad Díaz Cambriles8, María Somoza9, Juan F Masa10,4, Mónica González11, Eva Mañas12, Mónica de la Peña13, Francisco García-Río14,4, Josep María Montserrat15,4, Alfonso Muriel16, Grace Oscullo1, Alberto García-Ortega1, Tomás Posadas1, Francisco Campos-Rodríguez17,4, Miguel-Ángel Martínez-García1,4. 1. Pneumology Department, Hospital Universitario and Politécnico La Fe, Valencia. 2. Internal Medicine Service, Hospital Universitari de Santa María. 3. Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria. 4. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 5. Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida. 6. Respiratory Department, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS), Seville. 7. Respiratory Department, Hospital Universitario Vall Hebrón, Barcelona. 8. Respiratory Department, Hospital Universitario 12 de Octubre, Madrid. 9. Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona. 10. Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres. 11. Respiratory Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander. 12. Respiratory Department, Hospital Universitario Ramón and Cajal, Madrid. 13. Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca. 14. Respiratory Department, Hospital Universitario La Paz, IdiPAZ, Madrid. 15. Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona. 16. Biostatistic Unit, Hospital Ramón y Cajal, IRYCIS, CIBERESP, Nursery Department and Physiotherapy, Alcalá University, Madrid. 17. Respiratory Department, Hospital Universitario Valme, Institute of Biomedicine of Seville (IBiS). Sevilla.
Abstract
INTRODUCTION: Short-term treatment with continuous positive airway pressure (CPAP) produces a clinically significant reduction in blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension. However, it is unknown whether this effect continues over the long-term. Our objective was to assess the effect of long-term CPAP on BP in patients with OSA and resistant hypertension. METHODS: The study included 161 patients diagnosed with both OSA [apnea--hypopnea index (AHI) ≥15] and resistant hypertension diagnosed via 24-hour ambulatory BP measurement (24-h ABPM), in whom a second analysis via 24-h ABPM was performed at the end of the follow-up. RESULTS: Patients were followed up within 59 months [interquartile range (IQR): 44-70]. CPAP treatment was prescribed to 82% of the patients (70% with good adherence to CPAP defined as use of CPAP at least 4 h/night). A comparison between the adherent group and nonadherent group (including those with CPAP not prescribed) showed that CPAP adherents had a significant drop in the 24-h BP, both systolic [-3.9 mmHg; 95% confidence interval (CI): -8.1 to 0.3] and diastolic pressure (-3.5 mmHg [95% [CI]: -6.4-0.5]), with a higher magnitude during the night (-5.5 and -4.9 mmHg, respectively). The CPAP adherent group needed a mean of 1.1 less antihypertensive drugs (particularly spironolactone). Finally, there was a positive correlation between the drop in 24-h SBP and the hours of CPAP use (r = 0.24; P = 0.01). CONCLUSION: Good adherence to long-term CPAP treatment largely succeeded in significantly reducing BP in those patients with OSA and resistant hypertension, despite the use of a lower number of antihypertensive drugs.
INTRODUCTION: Short-term treatment with continuous positive airway pressure (CPAP) produces a clinically significant reduction in blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension. However, it is unknown whether this effect continues over the long-term. Our objective was to assess the effect of long-term CPAP on BP in patients with OSA and resistant hypertension. METHODS: The study included 161 patients diagnosed with both OSA [apnea--hypopnea index (AHI) ≥15] and resistant hypertension diagnosed via 24-hour ambulatory BP measurement (24-h ABPM), in whom a second analysis via 24-h ABPM was performed at the end of the follow-up. RESULTS:Patients were followed up within 59 months [interquartile range (IQR): 44-70]. CPAP treatment was prescribed to 82% of the patients (70% with good adherence to CPAP defined as use of CPAP at least 4 h/night). A comparison between the adherent group and nonadherent group (including those with CPAP not prescribed) showed that CPAP adherents had a significant drop in the 24-h BP, both systolic [-3.9 mmHg; 95% confidence interval (CI): -8.1 to 0.3] and diastolic pressure (-3.5 mmHg [95% [CI]: -6.4-0.5]), with a higher magnitude during the night (-5.5 and -4.9 mmHg, respectively). The CPAP adherent group needed a mean of 1.1 less antihypertensive drugs (particularly spironolactone). Finally, there was a positive correlation between the drop in 24-h SBP and the hours of CPAP use (r = 0.24; P = 0.01). CONCLUSION: Good adherence to long-term CPAP treatment largely succeeded in significantly reducing BP in those patients with OSA and resistant hypertension, despite the use of a lower number of antihypertensive drugs.