Baseline pulse wave velocity was above the normal range in 94% of patients.
After achieving target blood pressure, pulse wave velocity decreased by 1.9 ± 1.0 msec.
Effective CPAP therapy resulted in an additional reduction of 0.7 msec in pulse wave velocity.
Increased arterial stiffness persisted in 35% of patients receiving both antihypertensive treatment and effective CPAP.
The combination of antihypertensive treatment with effective CPAP led to significant reductions in augmentation index and .
Improvement in arterial stiffness parameters occurred alongside a decrease in central and brachial blood pressure.
Simplified
BACKGROUND: The aim of this study was to assess the effects of continuous positive airway pressure (CPAP) on arterial stiffness, central blood pressure, and reflected pulse wave characteristics in patients with severe obstructive sleep apnea (OSA) and stage 2-3 arterial hypertension.
METHODS: Forty-four patients with hypertension and severe OSA (apnea/hypopnea index > 30) received stepped dose titration of antihypertensive treatment, consisting of valsartan 160 mg + amlodipine 5-10 mg + hydrochlorothiazide 25 mg. CPAP therapy was added after 3 weeks of continuous antihypertensive treatment with BP < 140/90 mmHg or after adjusting triple treatment in patients with resistant arterial hypertension. The patients were randomized to effective CPAP (4-15 mm H2O) or placebo CPAP (pressure 4 mm H2O) for three weeks, then crossed over to the alternative treatment in a single-blind manner. Office blood pressure (BP), ambulatory BP monitoring, (AASI), aortic BP, (cfPWV), and systolic wave augmentation index were measured using a Sphygmocor® device at baseline, after antihypertensive treatment, placebo CPAP, and effective CPAP.
RESULTS: Baseline cfPWV was above the normal range in 94% of patients. After reaching target BP, the cfPWV decreased by 1.9 ± 1.0 msec (P = 0.007). Effective CPAP achieved a further cfPWV reduction of 0.7 msec (P = 0.03). Increased arterial stiffness (pulse wave velocity > 12 msec) persisted in 35% of patients on antihypertensive treatment and effective CPAP, in 56% of patients on antihypertensive treatment alone, and in 53% of patients on placebo CPAP. Only the combination of antihypertensive treatment with effective CPAP achieved a significant reduction in augmentation index and AASI, along with a further reduction in aortic and brachial BP.
CONCLUSION: Effective CPAP for 3 weeks resulted in a significant additional decrease in office BP, ambulatory BP monitoring, central BP, and augmentation index, together with an improvement in arterial stiffness parameters, ie, cfPWV and AASI, in a group of hypertensive patients with OSA.
Key numbers
6.7 ± 1.1 mmHg
Decrease in Central Systolic BP
Measured after adding effective CPAP to antihypertensive treatment.
0.7 m/sec
Reduction
Measured after effective CPAP therapy.
35%
Increased Arterial Stiffness Persistence
Observed in patients on combined therapy with effective CPAP.
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