Continuous positive airway pressure (CPAP) can significantly reduce blood pressure (BP) levels in patients with resistant hypertension and sleep apnea (OSA); however, the effect on patients with refractory hypertension (RfH) is not known. This study seeks to evaluate the effect of CPAP treatment on BP levels in patients with OSA and RfH, compared with those with OSA and resistant hypertension.
Post-hoc analysis of the HIPARCO randomized clinical trial on the effect of CPAP treatment on BP levels in patients with resistant hypertension. Those patients with uncontrolled 24-h ambulatory BP monitoring readings (>130 and/or >80 mmHg) in SBP or DBP were considered to have resistant hypertension (if they were taking three or four antihypertensive drugs) or RfH (if they were taking at least five drugs). OSA patients were randomized to receive CPAP or usual care for 3 months. They underwent a second 24-h ambulatory BP monitoring study to establish the effect of CPAP treatment on BP levels in both groups.
A total of 98 patients were randomized to CPAP (19 RfH/79 resistant hypertension) and 96 to usual care (21 RfH/75 resistant hypertension). BP readings dropped more marked in patients with RfH than resistant hypertension, in both 24-h SBP (−9 vs. −1.6 mmHg, P = 0.021) and 24-h DBP (−7.3 vs. −2.3 mmHg, P = 0.074), especially at night (−11.3 vs. −3.8, P = 0.121 and −8.8 vs. −2.2, P = 0.054) respectively. Adjusted difference between groups was statistically significant in 24-h SBP levels (−7.4 mmHg, P = 0.021).
CPAP lowers BP levels in both resistant hypertension and RfH patients although the degree of this reduction is higher in those with RfH especially during the night.
aPneumology Department, Hospital Universitario y Politécnico La Fe, Valencia
bInternal Medicine Service, Hospital Universitari de Santa María
cInstitut de Recerca Biomédica, IRB Lleida, Lleida
dRespiratory Department, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS), Seville
eRespiratory Department, Hospital Universitario Vall Hebrón, Barcelona
fRespiratory Department, Hospital Universitario 12 de Octubre, Madrid
gRespiratory Department, Consorcio Sanitario de Terrassa, Barcelona
hRespiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres
iRespiratory Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander
jRespiratory Department, Hospital Universitario Ramón y Cajal, Madrid
kRespiratory Department, Hospital Universitario Son Espases, Palma de Mallorca
lRespiratory Department, Hospital Universitario La Paz, IdiPAZ, Madrid
mRespiratory Department, Hospital Clinic-IDIBAPS, Barcelona
nBiostatistic Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
oVascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
pRespiratory Department, Hospital Universitario ValmE, Institute of Biomedicine of Seville (IBiS), Seville
qCIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain
Correspondence to Miguel-Angel Martínez-García, Pneumology Department, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46012 Valencia, Spain. Tel: +34 609865934; e-mail: firstname.lastname@example.org
Abbreviations: ABPM, ambulatory blood pressure monitoring; AHI, apnea-hypopnea index; BP, blood pressure; CPAP, continuous positive airway pressure; OSA, obstructive sleep apnea; RfH, refractory hypertension
Received 26 September, 2018
Revised 11 December, 2018
Accepted 2 January, 2019