Hypertension (Dallas, Tex. : 1979)Jan 21, 2015

Continuous positive airway pressure treatment and its effects on clinic and daily blood pressure in patients with obstructive sleep apnea and hard-to-treat high blood pressure

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 28, 2026

Abstract

A total of 117 patients with moderate/severe obstructive sleep apnea participated in a trial assessing CPAP's impact on blood pressure.

No significant difference was observed in clinic or ambulatory blood pressure changes between the CPAP and control groups.
59% of participants had uncontrolled ambulatory blood pressures.
The mean apnea-hypopnea index was 41 per hour, with 58.5% classified as having severe obstructive sleep apnea.
In per-protocol analysis, night-time systolic blood pressure showed a reduction of 4.7 mm Hg, although this was not statistically significant.
A 2.2% increase in nocturnal blood pressure fall was noted in the CPAP group compared to controls, also not statistically significant.

Simplified

The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129(16)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea-hypopnea index was 41 per hour and 58.5% had severe obstructive sleep apnea. On intention-to-treat analysis, there was no significant difference in any BP change, neither in nocturnal BP fall, between CPAP and control groups. The best effect of CPAP was on night-time systolic blood pressure in per-protocol analysis, with greater reduction of 4.7 mm Hg (95% confidence interval, -11.3 to +3.1 mm Hg; P=0.24) and an increase in nocturnal BP fall of 2.2% (95% confidence interval, -1.6% to +5.8%; P=0.25), in comparison with control group. In conclusion, CPAP treatment had no significant effect on clinic and ambulatory BPs in patients with resistant hypertension and moderate/severe obstructive sleep apnea, although a beneficial effect on night-time systolic blood pressure and on nocturnal BP fall might exist in patients with uncontrolled ambulatory BP levels.

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Continuous positive airway pressure treatment and its effects on clinic and daily blood pressure in patients with obstructive sleep apnea and hard-to-treat high blood pressure

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