Positive effect of CPAP treatment on the control of difficult-to-treat hypertension

The aim of the present study was to analyse the role of continuous positive airway pressure (CPAP) treatment in patients with difficult-to-control hypertension (DC-HT) and sleep apnoea. An AutosetTM (ResMed, Sydney, Australia) study was performed in 60 patients diagnosed with DC-HT based on two 24-h ambulatory blood pressure monitorisation (ABPM) studies. CPAP was offered to patients with an apnoea/hypopnoea index (AHI) ≥15 events·h−1. After 3 months of treatment, repeat ABPM was performed to evaluate the effect of CPAP upon the blood pressure values. A total of 39 (65%) patients received CPAP treatment, but only 33 completed the study. The mean±sd systolic and diastolic blood pressures (SBP and DBP, respectively) were 154.8±14 and 90±8.8 mmHg. Patients had a mean±sd AHI of 37.7±18.2 events·h−1. Only three patients presented a dipper nocturnal pressure pattern. CPAP treatment significantly reduced SBP (-5.2 mmHg), and particularly the nocturnal values (-6.1 mmHg), but not DBP. Considering only those patients who tolerated CPAP, the decrease in SBP was greater (-7.3 mmHg). Furthermore, CPAP treatment significantly increased the percentage of patients who recovered the dipper pattern (three (9.1%) out of 33 versus 12 (36.4%) out of 33). Continuous positive airway pressure treatment significantly reduces systolic blood pressure, particularly at night, and normalises the nocturnal pressure pattern in patients with difficult-to-control hypertension and sleep apnoea.

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