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Effects of continuous positive airway pressure on blood pressure in hypertensive patients with obstructive sleep apnea: a 3-year follow-up

Kasiakogias, Alexandrosa; Tsioufis, Costasa; Thomopoulos, Costasa; Aragiannis, Dimitriosa; Alchanatis, Manosb; Tousoulis, Dimitriosa; Papademetriou, Vasiliosc; Floras, John S.d; Stefanadis, Christodoulosa

doi: 10.1097/HJH.0b013e32835bdcda

Objective: Several studies have reported a small yet significant decrease in blood pressure (BP) with continuous positive airway pressure (CPAP) application in patients with obstructive sleep apnea (OSA). We investigated the long-term efficiency of CPAP in the management of hypertensive patients with OSA on top of conventional antihypertensive medication.

Methods: We followed 91 nonsleepy patients (aged 54 ± 9 years, 69 men) with essential hypertension and newly diagnosed moderate-to-severe OSA (apnea–hypopnea index, 38 ± 24 events/h on polysomnography) for a mean period of 3.1 years, after switching them to antihypertensive treatment targeting office BP less than 140/90 mmHg (<130/80 mmHg in diabetic patients). Participants were defined as on-CPAP if they adhered to CPAP treatment during the whole follow-up period (N = 41), whereas those that did not follow CPAP therapy served as controls (N = 50).

Results: By the end of follow-up, on-CPAP patients and controls exhibited similar SBP and DBP levels (133 ± 12 versus 133 ± 13 mmHg, 84 ± 9 versus 85 ± 9 mmHg, respectively, P > 0.05 for all), number of patients with controlled hypertension (71 versus 70%, P > 0.05), and number of antihypertensive drugs needed to achieve BP control (2.28 ± 1.09 versus 2.11 ± 0.72, P > 0.05). In a subgroup of patients (N = 34) in whom ambulatory BP monitoring was also performed, 24-h BP levels did not differ between the two groups (125 ± 10/76 ± 7 mmHg versus 123 ± 11/75 ± 10 mmHg, P > 0.05). In multiple regression models, CPAP application was not associated with changes in BP levels.

Conclusion: In nonsleepy, hypertensive, OSA patients on conventional antihypertensive treatment, long-term CPAP application is not associated with lower BP levels or a need for less antihypertensive drugs for BP control.

aFirst Cardiology Clinic, University of Athens Medical School, Hippokration Hospital

bFirst Respiratory Medicine Department, University of Athens Medical School, Sotiria Chest Diseases Hospital, Athens, Greece

cVeterans Affairs Medical Center, Cardiology Department and Georgetown, Medical Centers, Washington, District of Columbia, USA

dFaculty of Medicine, University of Toronto, Ontario, Canada

Correspondence to Costas Tsioufis, MD, 3 Kolokotroni Street, 15236 P. Penteli, Athens, Greece. Tel: +30 210 613 1393; fax: +30 213 208 9522; e-mail:

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; AHI, apnea–hypopnea index; ARB, angiotensin receptor blocker; BP, blood pressure; CCB, calcium channel blocker; CPAP, continuous positive airway pressure; ESS, epworth sleepiness scale; ESSQ, epworth sleepiness scale questionnaire; OSA, obstructive sleep apnea

Received 9 July, 2012

Revised 27 September, 2012

Accepted 25 October, 2012

© 2013 Lippincott Williams & Wilkins, Inc.