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This Article Full Text (PDF) All Versions of this Article: chest.07-1478v1 132/6/1847    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by CAMPOS-RODRIGUEZ, F. Articles by ALMEIDA-GONZALEZ, C. Search for Related Content PubMed PubMed Citation Articles by CAMPOS-RODRIGUEZ, F. Articles by ALMEIDA-GONZALEZ, C.

LONG-TERM EFFECT OF CPAP ON BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND SLEEP APNEA.

¹ Department of Respiratory Medicine ² Department of Internal Medicine ³ Department of Statistical Analyses. Valme University Hospital. Ctra. Cádiz S/N, 41014 Sevilla, Spain

fcamposr{at}telefonica.net

Abstract

Objective: To analyse the long-term effect of continuous positive airway pressure (CPAP) on ambulatory BP in patients with obstructive sleep apnea (OSA) and hypertension, and to identify subgroups of patients in whom CPAP could be more effective.

Methods: We conducted a prospective, long-term follow-up trial (24 months) in 55 patients with OSA and hypertension (mean CPAP use 5.3±1.9 h/d). 24-hour ambulatory blood pressure monitoring (ABPM) was measured at baseline and after intervention with CPAP, on an intention to treat basis. In addition, the correlation between the changes in 24-hour mean BP (24hMAP) and CPAP compliance, OSA severity and baseline ABPM was assessed.

Results: At the end of follow-up, a significant decrease was shown only in diastolic BP (-2.2 mmHg, [95%CI -4.2 to -0.1], p=0.03), but not in 24hMAP or other ABPM parameters. However, a correlation between the changes in 24hMAP and baseline systolic BP (r=-0.43, p=0.001), diastolic BP (r=-0.38, p=0.004) and hours of use of CPAP (r=-0.30, p=0.02) was observed. A significant decrease in the 24hMAP was achieved in a subgroup of patients with incompletely controlled hypertension at entry (-4.4 mmHg, [95%CI -7.9 to -0.9], p=0.01) as well as in those with CPAP compliance >5.3 h/d (-5.3 mmHg, [95%CI -9.5 to -1.2], p=0.01). Linear regression analysis showed that baseline systolic BP and hours of CPAP were independent predictors of reductions in BP with CPAP.

Conclusion: Long-term CPAP reduced BP modestly in the whole sample. However, patients with higher BP at entry and good CPAP compliance achieved significant reductions in BP.

Key Words: Hypertension • Sleep apnea syndromes • Continuous positive airway pressure • Ambulatory blood pressure monitoring