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Effects of obstructive sleep apnea treatment on blood pressure in patients with resistant hypertension: a randomized trial
Pedrosa RP, Drager LF, de Paula LKG, Amaro ACS, Bortolotto LA, Lorenzi-Filho G
Chest 2013 Nov;144(5):1487-1494
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Obstructive sleep apnea is extremely common among patients with resistant hypertension. However, the impact of the treatment of obstructive sleep apnea with continuous positive airway pressure on blood pressure in patients with resistant hypertension is not well established. METHODS: In the present study, 40 patients with confirmed resistant hypertension and moderate to severe obstructive sleep apnea confirmed by full polysomnography were randomized to medical therapy or medical treatment plus continuous positive airway pressure for 6 months. Patients were evaluated at study baseline and after 6 months by 24-hr ambulatory blood pressure monitoring. RESULTS: Thirty-five patients (77% males, age 56 +/- 1 years, body mass index 32 (28 to 39) kg/m2, apnea-hypopnea index 29 (24 to 48) events/hr, Epworth Sleepiness Scale 10 +/- 1, systolic/diastolic office BP 162 +/- 4/97 +/- 2 mmHg, on 4 (4 to 5) antihypertensive drugs completed the study. Continuous positive airway pressure was used for 6:01 +/- 0:20 (range 3:42 to 7:44) hours/night. Compared to the control group, awake systolic/diastolic ambulatory blood pressure monitoring decreased significantly in the continuous positive airway pressure group (delta +3.1 +/- 3.3 /+2.1 +/- 2.7 versus -6.5 +/- 3.3/-4.5 +/- 1.9 mmHg, respectively, p < 0.05). Interestingly, the blood pressure changes were only observed while patients were awake, but not during nocturnal ambulatory blood pressure monitoring (delta +2.8 +/- 4.5/+1.8 +/- 3.5 versus +1.6 +/- 3.5/+0.8 +/- 2.9 mmHg, p = NS). CONCLUSIONS: The treatment of obstructive sleep apnea with continuous positive airway pressure significantly reduces daytime blood pressure in patients with resistant hypertension. Therefore, our study reinforces the importance of recognizing and treating obstructive sleep apnea in patients with resistant hypertension. Clinical trial registered with www.ClinicalTrials.gov (NCT00812695).

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