In patients with obstructive sleep apnea and resistant hypertension, CPAP reduced 24-hour blood pressure

摘要

194 patients aged 18 to 75 years (mean age 56 y, 69% men) who had OSA (apnea-hypopnea index [AHI] >= 15) based on overnight polysomnography (attended respiratory polygraphy) and primary resistant hypertension (systolic blood pressure [SBP] > 130 mm Hg, diastolic blood pressure [DBP] > 80 mm Hg, or both despite use of > 3 antihypertensive medications including a diuretic, if not contraindicated) based on 24-hour ambulatory BP monitoring. Exclusion criteria included hypertension due to primary aldosteronism, renal artery stenosis, or renal insufficiency; disabling hypersomnia; current use of CPAP; poor adherence to antihypertensive treatment; cardiovascular event in the previous month; or use of oral corticosteroids, nonsteroidal antiinflamma-tory drugs, sedatives, or alcohol (> 100 g/d). Intervention: Nightly fixed-pressure CPAP, titrated to optimal pressure with an automatic CPAP device in a sleep laboratory = 98), or no CPAP (n = 96). All patients maintained their antihypertensive medication regimens. Outcomes: Primary outcome was change in 24-hour ambulatory mean BP from baseline. Secondary outcomes included change in diurnal and nocturnal SBP and DBP. Patient follow-up: 90% (intention-to-treat analysis).