Effects of OSA Treatment on BP in Patients With Resistant Hypertension

Pedrosa, Rodrigo Pinto; Drager, Luciano F.; Paula, Lílian K.G. de; Amaro, Aline C.S.; Bortolotto, Luiz Aparecido; Lorenzi-Filho, Geraldo

doi:10.1378/chest.13-0085

Cited by 178 publications

(139 citation statements)

References 34 publications

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“…Cohort studies including the Sleep Heart Health Study have consistently demonstrated that over 50% of individuals with OSA have hypertension [1,11,12]. Sustained and effective treatment of OSA with continuous positive airway pressure (CPAP) has been reported to improve daytime symptoms and quality of life [13,14] and to reduce blood pressure [15], one of the major risk factors for aortic dilation [16].…”

Section: Introductionmentioning

confidence: 99%

The impact of obstructive sleep apnoea on the aorta

2015

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Obstructive sleep apnoea (OSA) has been shown to be a causal factor in the pathogenesis of vascular dysfunction and hypertension, conditions which can promote dilation and subsequent aortic dissection and rupture. The objective of this review is to summarise the current literature on the possible association between OSA and aortic disease and delineate the underlying mechanisms.Relevant studies were found by searching for terms including "obstructive sleep apnoea" in combination with "aortic aneurysm, dissection, and dilation" in the MEDLINE and EMBASE databases.Observational studies consistently reported that OSA is highly prevalent among patients with aortic aneurysms and aortic dissections. Patients with co-occurring OSA and Marfan's syndrome as well as patients at the more severe end of the spectrum of OSA seem to be especially vulnerable to aortic disease.Several mechanisms are discussed concerning the link between OSA and aortic disease: nocturnal negative intrathoracic pressure surges leading to mechanical stretching of the aorta and ultimately aortic distension; arousal-induced reflex sympathetic activation with subsequent hypertension; and intermittent hypoxia associated with autonomic nervous system activation and consequently increased oxidative stress. Further well controlled studies are needed in order to define the exact role of OSA as a risk factor for aortic disease. @ERSpublications Several studies have shown an association between obstructive sleep apnoea and aortic aneurysms/dissections http://ow.ly/Nh9jc

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Section: Introductionmentioning

confidence: 99%

The impact of obstructive sleep apnoea on the aorta

2015

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“…6 Nevertheless, only 4 previous randomized controlled trials (RCT) evaluated it. [15][16][17][18] Three of them 15,16,18 had low sample sizes and the largest one 17 evaluated CPAP treatment during only a 3-month period, which might have been insufficient for full CPAP effect on BP reduction. 19 A recent meta-analysis 20 of the first 3 studies still suggested only modest ambulatory BP reductions of 1.8 to 3.9 mm Hg on systolic blood pressure (SBP) and 2.5 to 3.5 mm Hg on diastolic blood pressure (DBP).…”

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confidence: 99%

Effects of Continuous Positive Airway Pressure Treatment on Clinic and Ambulatory Blood Pressures in Patients With Obstructive Sleep Apnea and Resistant Hypertension

et al. 2015

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Abstract-The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129 (16)

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“…[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.…”

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confidence: 99%