Effects of OSA treatment on BP in patients with resistant hypertension: a randomized trial.

BACKGROUND OSA is extremely common among patients with resistant hypertension (HTN). However, the impact of the treatment of OSA with CPAP on BP in patients with resistant HTN is not well established. METHODS In the current study, 40 patients with confirmed resistant HTN and moderate to severe OSA confirmed by full polysomnography were randomized to medical therapy or to medical treatment plus CPAP for 6 months. Patients were evaluated at study baseline and after 6 months by 24-h ambulatory BP monitoring (ABPM). RESULTS Thirty-five patients (77% men; age, 56 ± 1 years; BMI, median 32 kg/m² [25%-75%, 28-39 kg/m²]; apnea-hypopnea index, 29 events/h [24-48 events/h]; Epworth Sleepiness Scale, 10 ± 1; systolic/diastolic office BP, 162 ± 4/97 ± 2 mm Hg; taking four [four to five] antihypertensive drugs) completed the study. CPAP was used for 6:01 ± 0:20 h/night (3:42-7:44 h/night). Compared with the control group, awake systolic/diastolic ABPM decreased significantly in the CPAP group (Δ: +3.1 ± 3.3 /+2.1 ± 2.7 mm Hg vs -6.5 ± 3.3/-4.5 ± 1.9 mm Hg, respectively, P < .05). Interestingly, the BP changes were observed only while patients were awake, but not during nocturnal ABPM (Δ: +2.8 ± 4.5/+1.8 ± 3.5 mm Hg vs +1.6 ± 3.5/+0.8 ± 2.9 mm Hg, P = NS). CONCLUSIONS The treatment of OSA with CPAP significantly reduces daytime BP in patients with resistant HTN. Therefore, our study reinforces the importance of recognizing and treating OSA in patients with resistant HTN. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00812695; URL: www.clinicaltrials.gov.

[1]  L. Bortolotto,et al.  Arousals are frequent and associated with exacerbated blood pressure response in patients with primary hypertension. , 2013, American journal of hypertension.

[2]  Cheryl C. H. Yang,et al.  Sleep disturbance among spontaneously hypertensive rats is mediated by an α1-adrenergic mechanism. , 2012, American journal of hypertension.

[3]  Sandra C Fuchs,et al.  Prevalência de hipertensão resistente em adultos não idosos: estudo prospectivo em contexto ambulatorial , 2012 .

[4]  D. Calhoun,et al.  Resistant hypertension, obstructive sleep apnoea and aldosterone , 2012, Journal of Human Hypertension.

[5]  T. Douglas Bradley,et al.  Obstructive Sleep Apnea: The Most Common Secondary Cause of Hypertension Associated With Resistant Hypertension , 2011, Hypertension.

[6]  B. Egan,et al.  Uncontrolled and Apparent Treatment Resistant Hypertension in the United States, 1988 to 2008 , 2011, Circulation.

[7]  Stephen D. Persell.  Prevalence of Resistant Hypertension in the United States, 2003–2008 , 2011, Hypertension.

[8]  J. Václavík,et al.  Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT): A Randomized, Double-Blind, Placebo-Controlled Trial , 2011, Hypertension.

[9]  R. Pedrosa,et al.  The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea , 2011, Hypertension.

[10]  J. Stradling,et al.  Mechanisms of vascular damage in obstructive sleep apnea , 2010, Nature Reviews Cardiology.

[11]  P. Lloberes,et al.  Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial , 2010, Journal of hypertension.

[12]  L. Bortolotto,et al.  Obstructive sleep apnea, masked hypertension, and arterial stiffness in men. , 2010, American journal of hypertension.

[13]  V. Somers,et al.  Obstructive sleep apnea and aldosterone. , 2009, Sleep.

[14]  C. Baigent,et al.  Revascularization versus medical therapy for renal-artery stenosis. , 2009, The New England journal of medicine.

[15]  G. Kinasewitz,et al.  Effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea. , 2009, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[16]  L. Bortolotto,et al.  Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis , 2009, Hypertension.

[17]  D. Goff,et al.  Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. , 2008, Circulation.

[18]  L. Bortolotto,et al.  Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. , 2007, American journal of respiratory and critical care medicine.

[19]  K. Reynolds,et al.  Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea , 2007, Hypertension.

[20]  M. Martínez-García,et al.  Positive effect of CPAP treatment on the control of difficult-to-treat hypertension , 2007, European Respiratory Journal.

[21]  L. Bortolotto,et al.  Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. , 2007, Chest.

[22]  A. Dupont,et al.  The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. , 2007, Archives of internal medicine.

[23]  J. C. Prado,et al.  Validity of four indirect methods to measure adherence in primary care hypertensives , 2007, Journal of Human Hypertension.

[24]  J. Fleetham,et al.  Impact of Continuous Positive Airway Pressure Therapy on Blood Pressure in Patients with Obstructive Sleep Apnea Hypopnea: A Meta-analysis of Randomized Controlled Trials , 2007, Lung.

[25]  S. Ancoli-Israel,et al.  Effects of Continuous Positive Airway Pressure Versus Supplemental Oxygen on 24-Hour Ambulatory Blood Pressure , 2006, Hypertension.

[26]  Fernando Costa,et al.  Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. , 2005, Circulation.

[27]  L. Bortolotto,et al.  Early signs of atherosclerosis in obstructive sleep apnea. , 2005, American journal of respiratory and critical care medicine.

[28]  Daniel W. Jones,et al.  Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. , 2005, Hypertension.

[29]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[30]  D. Møller,et al.  Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. , 2003, American journal of hypertension.

[31]  A. Logan,et al.  Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex , 2003, European Respiratory Journal.

[32]  Thomas Penzel,et al.  Effect of Nasal Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients With Obstructive Sleep Apnea , 2003, Circulation.

[33]  Jan A Staessen,et al.  Cardiovascular protection and blood pressure reduction: a meta-analysis , 2001, The Lancet.

[34]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.