The Antihypertensive Effect of Positive Airway Pressure on Resistant Hypertension of Patients with Obstructive Sleep Apnea: A Randomized, Double-Blind, Clinical Trial

Oliveira, Ana Claudia Tonelli de; Martinez, Dênis; Massierer, Daniela; Gus, Miguel; Gonçalves, Sandro Cadaval; Ghizzoni, Flávia; Steinhorst, Ana Maria Pasquali; Moreira, Leila Beltrami; Fuchs, Sandra Cristina Pereira Costa; Fuchs, Flávio Danni

doi:10.1164/rccm.201403-0479le

Cited by 53 publications

(47 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is the plausible reason why we had a relatively high proportion of patients with controlled ambulatory BP levels (41%) and their ambulatory BP levels were lower than those reported in previous RCTs. [15][16][17][18] It also probably explains the lesser effect of CPAP on ambulatory BP levels in our study in comparison with the previous ones. Finally, all our patients had valid baseline and final ABPM examinations and no missing values imputation was used.…”

Section: Discussionsupporting

confidence: 46%

“…This is the fifth RCT on the effects of CPAP treatment on BPs in patients with resistant hypertension and OSA, and the largest one of the unicenter trials. 15,16,18 The first RCT 15 randomized 29 resistant hypertensive patients (20 with uncontrolled ambulatory BPs) to 3-month CPAP treatment and 35 patients (21 with uncontrolled BPs) to control group; and observed no significant BP reduction in the whole study group. The best CPAP effect was a borderline significant 3.1 mm Hg reduction on night-time DBP (P=0.08).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, another small unicenter RCT was reported as a research letter. 18 It randomized 22 patients to 8-week CPAP treatment and 23 to sham-CPAP and observed an impressive 10 mm Hg 24-hour SBP reduction in the CPAP group. Our results mainly agreed with the first 15 and third trials 17 by showing a predominant CPAP effect on nighttime SBP levels and on nocturnal SBP fall and nondipping/riser patterns, but with lesser magnitude of reductions than these previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…15,17,18 Second, this was the group of patients with resistant hypertension most intensively treated before CPAP beginning. In previous RCTs, [15][16][17][18] patients were treated by a median of 3 to 4 antihypertensive drugs and none of them reported the use of mineralocorticoid receptor blockers, which are currently the drug of choice to be added to antihypertensive treatment of uncontrolled resistant hypertensive patients. 22,23 In our study, patients were treated by a median of 5 antihypertensive drugs (2 at bedtime), and almost half of them were using spironolactone.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

mentioning

confidence: 99%

See 4 more Smart Citations

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

View full text Add to dashboard Cite

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)

show abstract

Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea

Bratton

Gaisl

Wons

et al. 2015

JAMA

277

189

View full text Add to dashboard Cite

IMPORTANCE Obstructive sleep apnea is associated with higher levels of blood pressure (BP), which can lead to increased cardiovascular risk.OBJECTIVE To compare the association of continuous positive airway pressure (CPAP), mandibular advancement devices (MADs), and inactive control groups (placebo or no treatment) with changes in systolic BP (SBP) and diastolic BP (DBP) in patients with obstructive sleep apnea.DATA SOURCES The databases of MEDLINE, EMBASE, and the Cochrane Library were searched up to the end of August 2015 and study bibliographies were reviewed. STUDY SELECTION Randomized clinical trials comparing the effect of CPAP or MADs (vs each other or an inactive control) on BP in patients with obstructive sleep apnea were selected by consensus. Of 872 studies initially identified, 51 were selected for analysis.DATA EXTRACTION AND SYNTHESIS Data were extracted by one reviewer and checked by another reviewer. A network meta-analysis using multivariate random-effects meta-regression was used to estimate pooled differences between each intervention. Meta-regression was used to assess the association between trial characteristics and the reported effects of CPAP vs inactive control.MAIN OUTCOMES AND MEASURES Absolute change in SBP and DBP from baseline to follow-up. RESULTSOf the 51 studies included in the analysis (4888 patients), 44 compared CPAP with an inactive control, 3 compared MADs with an inactive control, 1 compared CPAP with an MAD, and 3 compared CPAP, MADs, and an inactive control. Compared with an inactive control, CPAP was associated with a reduction in SBP of 2.5 mm Hg (95% CI, 1.5 to 3.5 mm Hg; P < .001) and in DBP of 2.0 mm Hg (95% CI, 1.3 to 2.7 mm Hg; P < .001). A 1-hour-per-night increase in mean CPAP use was associated with an additional reduction in SBP of 1.5 mm Hg (95% CI, 0.8 to 2.3 mm Hg; P < .001) and an additional reduction in DBP of 0.9 mm Hg (95% CI, 0.3 to 1.4 mm Hg; P = .001). Compared with an inactive control, MADs were associated with a reduction in SBP of 2.1 mm Hg (95% CI, 0.8 to 3.4 mm Hg; P = .002) and in DBP of 1.9 mm Hg (95% CI, 0.5 to 3.2 mm Hg; P = .008). There was no significant difference between CPAP and MADs in their association with change in SBP (−0.5 mm Hg [95% CI, −2.0 to 1.0 mm Hg]; P = .55) or in DBP (−0.2 mm Hg [95% CI, −1.6 to 1.3 mm Hg]; P = .82). CONCLUSIONS AND RELEVANCEAmong patients with obstructive sleep apnea, both CPAP and MADs were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.

show abstract

When to Treat with CPAP and How to Define Success

Fashanu

Quan

2022

CPAP Adherence

View full text Add to dashboard Cite

The Antihypertensive Effect of Positive Airway Pressure on Resistant Hypertension of Patients with Obstructive Sleep Apnea: A Randomized, Double-Blind, Clinical Trial

Cited by 53 publications

References 15 publications

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

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

CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea

When to Treat with CPAP and How to Define Success

Contact Info

Product

Resources

About