Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial

Abstract

In patients with resistant hypertension and OSA, CPAP treatment for 3 months achieves reductions in 24-h BP. This effect is seen in patients with ABPM-confirmed resistant hypertension who use CPAP more than 5.8 h.

Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort

“…[16][17][18][19] Randomized clinical trials have demonstrated modest antihypertensive benefits of treatment of SDB with CPAP, with mild reductions in BP of 3 to 5 mm Hg 20,21 compared with more substantive reductions in RHTN, namely 7 to 10 mm Hg. 22 Notwithstanding the vast interventional trial data published on SDB and HTN, relatively fewer randomized studies [23][24][25] have investigated the effect of CPAP on control of BP in patients with OSA and RHTN, and none have examined the effect of CPAP in real-world clinical practice settings. 22,26,27 The limited data available in the "real-world" clinical practice setting suggests a reduction in mean arterial pressure (MAP) in a small sample of patients with resistant hypertension, and a negligible effect on hypertensive patients with controlled BP.…”

Response to Unmasking True Resistant Hypertension: Is the Real-World Resistance Just Revealed?

“…2 Second, we agree with Thomopoulos and Tsioufis 1 that sleep apnea syndrome could be an important cause of resistance, and it has been reported recently that continuous positive pressure therapy ameliorates blood pressure in resistant hypertensive patients. 4 Unfortunately, when the registry was initiated, a systematic collection of data regarding sleep apnea diagnosis and treatment was not planned.Third, we have performed additional analyses from our registry to provide data about the prevalence of masked resistant hypertension in our cohort. Thus, from the original cohort of 68 045 patients, we identified 2603 subjects who were treated with 3 antihypertensive drugs and had normal values for office blood pressure.…”

“…2 Second, we agree with Thomopoulos and Tsioufis 1 that sleep apnea syndrome could be an important cause of resistance, and it has been reported recently that continuous positive pressure therapy ameliorates blood pressure in resistant hypertensive patients. 4 Unfortunately, when the registry was initiated, a systematic collection of data regarding sleep apnea diagnosis and treatment was not planned.…”

Assessment and management of resistant hypertension

“…46 However, among patients with resistant hypertension, those who received continuous positive airway pressure had greater reductions in 24-hour ambulatory blood pressure than the controls (systolic −7.6 v. −0.6 mm Hg, p = 0.07; and diastolic −4.9 v. 0.1 mm Hg, p = 0.03). 46 Although these data should be considered preliminary and will require confirmation, continuous positive airway pressure is already indicated for sleep apnea; thus, it is reasonable to recommend it to patients with concomitant resistant hypertension to help improve blood pressure control.…”