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Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis

Iftikhar, Imran H.a; Valentine, Christopher W.b; Bittencourt, Lia R.A.c; Cohen, Debbie L.d; Fedson, Annette C.e; Gíslason, Thorarinnf; Penzel, Thomasg; Phillips, Craig L.h,i; Yu-sheng, Linj; Pack, Allan I.e; Magalang, Ulysses J.k

doi: 10.1097/HJH.0000000000000372
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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; I 2 58%) and −4.99 mmHg (95% CI: −6.01 to −3.96; P < 0.001; I 2 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; I 2 61%] and −5.94 mmHg (95% CI: −9.40 to −2.47; P = 0.001; I 2 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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aDivision of Pulmonary, Critical Care, and Sleep Medicine, University of South Carolina, Columbia, South Carolina

bDivision of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

cDisciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil

dRenal and Hypertension Division, University of Pennsylvania Perelman School of Medicine

eDivision of Sleep Medicine, Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

fFaculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland

gCenter of Sleep Medicine, Charité University Hospital, Berlin, Germany

hDepartment of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards

iWoodcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia

jDepartment of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taiwan, Republic of China

kDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

Correspondence to Ulysses J. Magalang, MD, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, 201 Davis Heart and Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210, USA. Tel: +1 614 247 7701; fax: +1 614 293 4799; e-mail: magalang.1@osu.edu

Abbreviations: ABPM, ambulatory blood pressure monitoring; AHI, apnea–hypopnea index; BP, blood pressure; CI, confidence interval; CPAP, continuous positive airway pressure; ESS, Epworth Sleepiness Score; I 2, marker for statistical heterogeneity; mmHg, millimeters of mercury; OSA, obstructive sleep apnea; RCT, randomized controlled trial

Received 12 January, 2014

Revised 6 August, 2014

Accepted 6 August, 2014

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

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