Abstract 12525: Continuous Positive Airway Pressure Does Not Improve Blood Pressure Control Beyond Standard Antihypertensive Treatment: A 3-Year Follow-Up Study
Introduction: A considerable number of studies has reported a small yet significant decrease in blood pressure (BP) with Continuous Positive Airway Pressure (CPAP) application at nighttime in patients with obstructive sleep apnea (OSA).
Hypothesis: We hypothesized that long-term CPAP treatment should be associated with at least a need for less antihypertensive drugs in patients with arterial hypertension.
Methods: We prospectively studied 81 patients (mean age 54±9 years old, 62 men) with essential hypertension and newly-diagnosed OSA (positive polysomnography) with an indication for CPAP therapy, for a mean period of 3.2 years. All subjects underwent office blood pressure measurements, echocardiography and routine blood testing and were prescribed antihypertensive treatment targeting optimal BP control. Based on their acceptance of CPAP therapy, patients were divided into two groups: CPAP adherent (N=35) and CPAP non-adherent (N=46).
Results: Apnea-Hypopnea Index (AHI) was significantly correlated with CPAP acceptance in the entire population (r=0.34, p=0.002). At the initial visit, CPAP-adherent compared to CPAP non-adherent patients did not differ regarding systolic and diastolic BP levels, number of antihypertensive drugs, metabolic profile and echocardiographic parameters. By the end of the follow-up period, office systolic and diastolic BP were significantly lower compared to baseline (133±12mmHg vs. 145±15mmHg and 85±9mmHg vs. 95±10mmHg respectively, p<0.001), while number of antihypertensive drugs applied was higher (2.3±1.2 vs. 1.7±1.5, p<0.001). Split-plot ANOVA did not show any significant effect of CPAP application on either systolic or diastolic BP change after controlling for AHI and changes in BMI and number of antihypertensive drugs (F=0.018 and 0.001 respectively, p>0.05). In logistic regression analysis, CPAP treatment did not predict achievement of target BP independent of confounders (p>0.05).
Conclusions: In hypertensive patients with OSA, long-term therapy with CPAP is not associated with lower BP levels or the need for less antihypertensive drugs. Optimizing drug treatment should be regarded as the principal therapeutic approach in this patient group.
- © 2011 by American Heart Association, Inc.