Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis
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OBJECTIVE: To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA). METHODS: Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment. RESULTS: A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I² 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I² 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I² 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I² 76%), respectively, in favor of the CPAP group. CONCLUSION: The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
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Several SRs and meta-analyses have noted reductions in blood pressure with CPAP treatment of OSA, particularly moderate-to-severe OSA, but caution is warranted due to heterogeneity in pooled studies.
“Although several SRs and meta-analyses have noted reductions in BP with CPAP treatment of OSA, particularly moderate to severe OSA, caution is warranted because of heterogeneity in the pooled studies.39,654,1207–1211”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1210]
The Introduction and Discussion report that several meta-analyses found blood-pressure reductions with CPAP in patients with OSA. The Methods assess heterogeneity, and the Results identify significant heterogeneity in some trial subgroups. The paper focuses on OSA with resistant hypertension; it does not establish the claim’s particular emphasis on moderate-to-severe OSA. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThese meta-analyses showed a significant decrease in nighttime blood pressure and a long-term (12 weeks) reduction in mean and diastolic blood pressure with CPAP use of 4 or more hours per night.
“These meta-analyses have shown a significant decrease in nighttime BP as well as a long-term (12 weeks) reduction in mean and diastolic BP with CPAP device usage of 4 or more hours a night.39,1210,1211”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1210]
The Results sections report significant reductions in 24-hour blood pressure and an association between more hours of CPAP use and greater diastolic response. But the nocturnal analyses did not reach statistical significance, contrary to the claimed significant nighttime decrease. The paper pooled interventions lasting three weeks to six months and does not establish the stated 12-week result specifically for use of at least four hours per night. (LLM, conf=0.89)
Experimental — accuracy not yet measuredMeta-analyses have indicated greater blood pressure reduction with CPAP in resistant hypertension, about 5-7 mmHg systolic and 3-5 mmHg diastolic.
“Meta-analyses have indicated a greater magnitude of BP reduction with CPAP therapy, in the range of 5–7 mmHg in systolic BP and 3–5 mmHg in diastolic BP, in those with resistant HTN.1210,1211”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1210]
CPAP therapy in OSA patients produces a modest reduction in mean systolic blood pressure (−4.92 mm Hg; 95%CI −8.70 to −1.14) and mean nighttime blood pressure (−2.56 mm Hg; 95% CI −4.43 to −0.68 mmHg), but no significant change in daytime SBP or DBP.
“Modest reduction in mean systolic blood pressure (SBP) (−4.92 mm Hg; 95%CI −8.70 to −1.14) and mean (−2.56 mm Hg; 95% CI −4.43 to −0.68 mmHg) nighttime blood pressure were seen. No significant change in daytime SBP (−0.74 mm Hg; 95% CI −3.9 to 2.41) and daytime diastolic blood pressure (−1.86 mm Hg; 95% CI −4.55 to 0.83) were observed, however.(115)”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [115]
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- Authors
- Iftikhar, I. H., Valentine, C. W., Bittencourt, L. R. A., Cohen, D. L., Fedson, A. C., Gíslason, T., Penzel, T., Phillips, C. L., Yu-sheng, L., Pack, A. I., & Magalang, U. J.
- Affiliations
- The University of Sydney (AU)
- The Ohio State University Wexner Medical Center (US)
- Universidade Federal de São Paulo (BR)
- University of Pennsylvania (US)
- Charité – Universitätsmedizin Berlin (DE)
- Taoyuan Chang Gung Memorial Hospital (TW)
- Corresponding author
- Magalang, Ulysses J.
- ORCID
- Venue
- Journal of Hypertension
- Published
- 2014-12
- Volume
- 32
- Issue
- 12
- Pages
- 2341-2350
- ISSN
- 0263-6352 (ISSN-L)
- PMC
- PMC4291165
- OpenAlex
- W2095580030
- Semantic Scholar
- 97d6f03d465a5ab46865d44e6004b532716eb7e3
- Cited by
- 215
- References
- 49
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 16 · 2023: 13 · 2022: 18 · 2021: 19 · 2020: 18 · 2019: 29 · 2018: 31 · 2017: 15 · 2016: 18 · 2015: 17 · 2014: 1
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- UNIFESP Institutional Repository (Universidade Federal de São Paulo) (submittedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- Funders
- Ohio State University
- National Institutes of Health (UL1TR001070, UL1TR000090)
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston
- National Heart, Lung, and Blood Institute (HL-093463, P01HL094307, R01HL093463)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- continuous positive airway pressure, resistant hypertension, obstructive sleep apnea, blood pressure reduction, ambulatory blood pressure
- MeSH terms
- Aged, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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