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CPAP helps control BP in apnoea patients

Mean BP fell after CPAP in people with sleep apnoea and resistant hypertension

Louise Prime

Wednesday, 11 December 2013

People with resistant hypertension and obstructive sleep apnoea (OSA) who were treated with continuous positive airway pressure (CPAP) had a significant improvement in their blood pressure control compared with similar patients who did not receive CPAP, research* published today in JAMA has shown.

Other recent studies had already shown that OSA might contribute to poor control of hypertension, and also that OSA is present in more than two-thirds of people with resistant hypertension, i.e. hypertension that requires at least three drugs for adequate control. So researchers in Spain conducted a trial across 24 teaching hospitals in the country, looking at the effects of CPAP in 194 people with both resistant hypertension and OSA. Participants were assigned randomly to either CPAP or no CPAP, while still taking their usual antihypertensive medicines.

When the study authors analysed their results by intention to treat, patients assigned to CPAP had a 3.1mmHg greater decrease in 24-hour mean blood pressure, and 3.2mmHg greater decrease in 24-hour systolic blood pressure, compared with the control group; the number of hours for which CPAP was used correlated significantly with the reduction in 24-hour mean blood pressure. There was no significant difference in 24-hour systolic blood pressure between the groups.

At 12-week follow-up, more than a third (35.9%) of CPAP patients had a mean nocturnal blood pressure at least 10% lower than their mean daytime blood pressure – a nocturnal blood pressure dipper pattern – compared with fewer than a quarter (21.6%) of control patients.

The authors concluded: “Among patients with OSA and resistant hypertension, CPAP treatment for 12 weeks compared with control resulted in a decrease in 24-hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern. Further research is warranted to assess longer-term health outcomes.”

*doi:10.1001/jama.2013.281250

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