Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: ameta-analysis

• Published in: Journal of Hypertension
• Main Authors: Iftikhar, Imran H., Valentine, Christopher W., Bittencourt, Lia R. A. UNIFESP, Cohen, Debbie L., Fedson, Annette C., Gislason, Thorarinn, Penzel, Thomas, Phillips, Craig L., Lin Yu-sheng, Pack, Allan I., Magalang, Ulysses J.
• Other Authors: Univ S Carolina, Ohio State Univ, Universidade Federal de São Paulo (UNIFESP), Univ Penn, Univ Iceland, Charite, Royal N Shore Hosp, Univ Sydney, Taoyuan Chang Gung Mem Hosp
• Format: Review
• Language: English
• Published: Lippincott Williams & Wilkins 2014
• Subjects: blood pressure; continuous positive airway pressure; meta-analysis; obstructive sleep apnea; resistant hypertension; Iceland
• Online Access: http://repositorio.unifesp.br/handle/11600/38527; https://doi.org/10.1097/HJH.0000000000000372

Objective: To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).Methods: Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.Results: A total of six studies met the inclusion criteria for preintervention to postintervention analyses. the pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I-2 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I-2 31%), respectively. the pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I-2 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I-2 76%), respectively, in favor of the CPAP group.Conclusion: the pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. the effects sizes are larger than those previously reported in patients with OSA without resistant hypertension. NHLBI of the Ohio State University Center for Clinical and Translational Science Univ S Carolina, Div Pulm Crit Care & Sleep Med, Columbia, SC 29208 USA Ohio State Univ, Wexner Med Ctr, Div Nephrol, Columbus, OH 43210 USA Universidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, São Paulo, Brazil Univ Penn, Perelman Sch Med, Renal & Hypertens Div, Philadelphia, PA 19104 USA Univ Penn, Perelman Sch Med, Ctr Sleep & Circadian Neurobiol, Div Sleep Med, Philadelphia, PA 19104 USA Univ Iceland, Sch Hlth Sci, Fac Med, Reykjavik, Iceland Charite, Ctr Sleep Med, Berlin, Germany Royal N Shore Hosp, Dept Resp & Sleep Med, St Leonards, ...