Original Research: Sleep Disorders |

Effects of OSA Treatment on BP in Patients With Resistant HypertensionEffects of OSA Treatment on BP: A Randomized Trial

Rodrigo P. Pedrosa, MD, PhD; Luciano F. Drager, MD, PhD; Lílian K. G. de Paula, RpT; Aline C. S. Amaro, RpT; Luiz A. Bortolotto, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD
Author and Funding Information

From the Sleep Laboratory (Drs Pedrosa, Drager, and Lorenzi-Filho and Mss de Paula and Amaro), Pulmonary Division, and the Hypertension Unit (Drs Drager and Bortolotto), Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo; and the Sleep and Heart Laboratory (Dr Pedrosa), Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Brazil.

Correspondence to: Geraldo Lorenzi-Filho, MD, PhD, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar, 44, São Paulo, Brazil; e-mail: geraldo.lorenzi@incor.usp.br

For editorial comment see page 1433

This study was presented at the American Thoracic Society International Conference 2012, May 18-23, 2012, in San Francisco, CA, as an oral presentation.

Funding/Support: This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP - 2008/57332-7), Fundação Zerbini.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(5):1487-1494. doi:10.1378/chest.13-0085
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Background:  OSA is extremely common among patients with resistant hypertension (HTN). However, the impact of the treatment of OSA with CPAP on BP in patients with resistant HTN is not well established.

Methods:  In the current study, 40 patients with confirmed resistant HTN and moderate to severe OSA confirmed by full polysomnography were randomized to medical therapy or to medical treatment plus CPAP for 6 months. Patients were evaluated at study baseline and after 6 months by 24-h ambulatory BP monitoring (ABPM).

Results:  Thirty-five patients (77% men; age, 56 ± 1 years; BMI, median 32 kg/m2 [25%-75%, 28-39 kg/m2]; apnea-hypopnea index, 29 events/h [24-48 events/h]; Epworth Sleepiness Scale, 10 ± 1; systolic/diastolic office BP, 162 ± 4/97 ± 2 mm Hg; taking four [four to five] antihypertensive drugs) completed the study. CPAP was used for 6:01 ± 0:20 h/night (3:42-7:44 h/night). Compared with the control group, awake systolic/diastolic ABPM decreased significantly in the CPAP group (Δ: +3.1 ± 3.3 /+2.1 ± 2.7 mm Hg vs −6.5 ± 3.3/−4.5 ± 1.9 mm Hg, respectively, P < .05). Interestingly, the BP changes were observed only while patients were awake, but not during nocturnal ABPM (Δ: +2.8 ± 4.5/+1.8 ± 3.5 mm Hg vs +1.6 ± 3.5/+0.8 ± 2.9 mm Hg, P = NS).

Conclusions:  The treatment of OSA with CPAP significantly reduces daytime BP in patients with resistant HTN. Therefore, our study reinforces the importance of recognizing and treating OSA in patients with resistant HTN.

Trial registry:  ClinicalTrials.gov; No.: NCT00812695; URL: www.clinicaltrials.gov

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