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Lowering Blood Pressure in Patients with Obstructive Sleep Apnea and Resistant Hypertension

Summary and Comment |
January 9, 2014

Lowering Blood Pressure in Patients with Obstructive Sleep Apnea and Resistant Hypertension

  1. Thomas L. Schwenk, MD

Treatment with continuous positive airway pressure yielded small but probably clinically important effects.

  1. Thomas L. Schwenk, MD

Patients with resistant hypertension (i.e., requiring ≥3 antihypertensive medications for even partial blood pressure [BP] control) often have obstructive sleep apnea (OSA). Small studies suggest that the usual treatment for OSA — continuous positive airway pressure (CPAP) — lowers BP in patients with resistant hypertension. In this multicenter trial, researchers in Spain randomized 194 adults (mean age, 56; 70% men) with resistant hypertension and OSA (mean apnea-hypopnea index, 40.4 events per hour) to CPAP or no OSA treatment.

At 12 weeks, CPAP patients, compared with control patients, had significantly greater reductions from baseline in 24-hour mean BP (3.1 mm Hg more) and 24-hour diastolic BP (3.2 mm Hg more) but not in 24-hour systolic BP. Also, a higher proportion of CPAP patients showed nocturnal drops in BP (36% vs. 22%).

Comment

These results are similar to those of a smaller study from Brazil (NEJM JW Gen Med Nov 14 2013). Patients with obstructive sleep apnea of this severity almost certainly are candidates for — and will benefit from — continuous positive airway pressure, regardless of the presence of hypertension. This study shows a small but clinically important additional benefit in lowering blood pressure in patients with resistant hypertension.

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

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