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Treating Obstructive Sleep Apnea in Patients with Resistant Hypertension

Summary and Comment |
November 14, 2013

Treating Obstructive Sleep Apnea in Patients with Resistant Hypertension

  1. Allan S. Brett, MD

In a randomized trial, continuous positive airway pressure lowered daytime ambulatory blood pressure.

  1. Allan S. Brett, MD

Many patients with resistant hypertension have obstructive sleep apnea (OSA). To determine whether treating OSA improves blood pressure (BP) in such patients, researchers in Brazil randomized 40 patients with resistant hypertension and OSA to receive medical treatment alone or medical treatment plus continuous positive airway pressure (CPAP). All patients had inadequately controlled BP (mean, 162/97 mm Hg) despite taking at least three antihypertensive drugs, and all had apnea/hypopnea indexes ≥15 per hour (mean, 29/hour).

Twenty-four-hour ambulatory BP monitoring at 6 months (compared with baseline) showed that mean daytime systolic and diastolic BP increased by 3 mm Hg and 2 mm Hg, respectively, in the control group and decreased by 7 mm Hg and 5 mm Hg in the CPAP group — both differences were significant. No differences in nocturnal BP were noted between groups. Antihypertensive drug regimens were not changed during follow-up. CPAP was used an average of 6 hours nightly.

Comment

According to the authors, this is the first randomized trial in which the effect of obstructive sleep apnea treatment on resistant hypertension was examined specifically. Although the results are promising, follow-up was relatively brief, the study was small, and adherence to continuous positive airway pressure was higher than we usually observe in practice. Why the effect was limited to daytime blood pressure is unclear.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Roberto Santso, MD Physician, Obstetrics/Gynecology, Ministry of Public Health, Guatemala

I suffer from high BP and Apnea, so it is interesting to follow up.

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