Effects of Continuous Positive Airway Pressure Treatment on Clinic and Ambulatory Blood Pressures in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Randomized Controlled Trial
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)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea–hypopnea index was 41 per hour and 58.5% had severe obstructive sleep apnea. On intention-to-treat analysis, there was no significant difference in any BP change, neither in nocturnal BP fall, between CPAP and control groups. The best effect of CPAP was on night-time systolic blood pressure in per-protocol analysis, with greater reduction of 4.7 mm Hg (95% confidence interval, −11.3 to +3.1 mm Hg; P =0.24) and an increase in nocturnal BP fall of 2.2% (95% confidence interval, −1.6% to +5.8%; P =0.25), in comparison with control group. In conclusion, CPAP treatment had no significant effect on clinic and ambulatory BPs in patients with resistant hypertension and moderate/severe obstructive sleep apnea, although a beneficial effect on night-time systolic blood pressure and on nocturnal BP fall might exist in patients with uncontrolled ambulatory BP levels.
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CPAP's effect on cardiovascular biomarkers such as C-reactive protein and lipids is more variable than its effect on blood pressure.
“Although most (but not all) studies and the above meta-analysis support a modest effect of CPAP on blood pressure, the effect on biomarkers associated with cardiovascular risk such as C-reactive protein has been more variable.”
From Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association (2016) · cites this paper as [168]
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Self-citation
- Authors
- Muxfeldt, E. S., Margallo, V., Costa, L. M. S., Guimarães, G., Cavalcante, A. H., Azevedo, J. C. M., de Souza, F., Cardoso, C. R. L., & Salles, G. F.
- Affiliations
- Universidade Federal do Rio de Janeiro (BR)
- From the Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Venue
- Hypertension
- Published
- 2015-04
- Volume
- 65
- Issue
- 4
- Pages
- 736-742
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2161355380
- Cited by
- 142
- References
- 37
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 11 · 2023: 17 · 2022: 9 · 2021: 9 · 2020: 10 · 2019: 9 · 2018: 16 · 2017: 23 · 2016: 12 · 2015: 13
- FWCI
- 15.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- 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, obstructive sleep apnea, resistant hypertension, blood pressure, ambulatory blood pressure monitoring, nocturnal blood pressure dipping, apnea-hypopnea index
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Treatment Outcome, Blood Pressure Monitoring, Ambulatory, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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