Long-Term Effects of Continuous Positive Airway Pressure on Blood Pressure and Prognosis in Hypertensive Patients with Coronary Heart Disease and Obstructive Sleep Apnea: A Randomized Controlled Trial

Aug 16, 2014American journal of hypertension

Long-term use of continuous airway pressure and its effects on blood pressure and outlook in high blood pressure patients with heart disease and sleep apnea

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Abstract

The use of CPAP for 4.5±1.1 hours per night significantly reduced daytime systolic blood pressure by 8 mm Hg in patients with obstructive sleep apnea and uncontrolled hypertension.

Daytime systolic blood pressure in the CPAP group decreased from 143±7 mm Hg to 139±7 mm Hg.
Hypertension control improved significantly with 69.4% of CPAP users achieving control compared to 43.2% in the control group.
No statistically significant difference was found in diastolic blood pressure between the groups.
The Epworth Sleepiness Scale score significantly decreased in the CPAP group, indicating reduced daytime sleepiness.
The occurrence of severe cardiovascular and cerebrovascular events was lower in the CPAP group, with 1 event compared to 5 in the control group, though this difference was not statistically significant.

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BACKGROUND: Obstructive sleep apnea (OSA) can result in hypertension and significantly increase cardiovascular morbidity and mortality. There are few reports on the long-term effects of continuous positive airway pressure (CPAP) on blood pressure in patients with uncontrolled hypertension with coronary heart disease (CHD) and OSA.

METHODS: We conducted a prospective, long-term follow-up study in 83 patients with uncontrolled hypertension, CHD, and OSA randomized to control or CPAP groups. Daytime systolic blood pressure (SBP), diastolic blood pressure (DBP), and severe cardiovascular and cerebrovascular events (SCCEs) were recorded at baseline and follow-up.

RESULTS: Seventy-three patients completed the study with a median follow-up of 36 (interquartile range = 24-54) months. The 2 groups had similar characteristics at baseline. CPAP was used for 4.5±1.1 hour/night. SBP in the CPAP group was significantly reduced at follow-up (143±7 mm Hg vs. 139±7 mm Hg, P = 0.04), and SBP decreased by 8mm Hg (95% confidence interval = 1.4-9.9; P = 0.01). Hypertension control was improved (CPAP, 69.4% for CPAP users vs. 43.2% for control subjects; P = 0.02); however, DBP did not reach statistical difference between the groups (81±10 mm Hg vs. 79±8 mm Hg; P = 0.49). In the CPAP group, the Epworth Sleepiness Scale was markedly reduced (7.0±3.4 vs. 3.7±2.3; P < 0.001). There was 1 SCCE in the CPAP group (heart failure), and 5 SCCEs in the control group (acute myocardial infarction: 2 (with 1 death); stroke: 3), but there was no significant difference identified.

CONCLUSIONS: Long-term CPAP application in uncontrolled hypertension with CHD and OSA significantly reduced daytime SBP, improved hypertension control and daytime sleepiness, and decreased the trend in SCCEs compared with control subjects.

CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02059993.

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Long-Term Effects of Continuous Positive Airway Pressure on Blood Pressure and Prognosis in Hypertensive Patients with Coronary Heart Disease and Obstructive Sleep Apnea: A Randomized Controlled Trial

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