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Original Research: Sleep Disorders |

Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort

Harneet K. Walia, MD; Sandra D. Griffith, PhD; Nancy Foldvary-Schaefer, DO; George Thomas, MD; Emmanuel L. Bravo, MD; Douglas E. Moul, MD, MPH; Reena Mehra, MD, FCCP
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the National Heart, Lung, and Blood Institute (NHLBI) [R21HL108226 and R01HL109493] and a Cleveland Clinic Neurological Institute-Core Scholar Award.

CORRESPONDENCE TO: Harneet K. Walia, MD, Center for Sleep Disorders, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(3):747-755. doi:10.1378/chest.15-0697
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Background  Clinic-based effectiveness studies of sleep-disordered breathing (SDB) treatment in reducing BP in resistant hypertension (RHTN) vs non-RHTN are sparse. We hypothesize that CPAP use in SDB reduces BP significantly in RHTN and non-RHTN in a large clinic-based cohort.

Methods  Electronic medical records were reviewed in patients with SDB and comorbid RHTN and non-RHTN for CPAP therapy initiation (baseline) and subsequent visits. We estimated generalizable BP changes from multivariable mixed-effects linear models for systolic BP (SBP), diastolic BP, and mean arterial pressure, adjusting for RHTN status, age, sex, race, BMI, cardiac history, and diabetes and repeated measure correlation.

Results  Of 894 patients, 130 (15%) had RHTN at baseline (age, 58 ± 12 years; 52% men; BMI, 36 ± 9 kg/m2). Patients with RHTN had significantly higher BP overall (P < .001), most notably for SBP (6.9 mm Hg; 95% CI, 3.84, 9.94). In the year following CPAP initiation, improvements in BP indexes did not generally differ based on RHTN status in which RHTN status was a fixed effect. However, there was a significant decrease in SBP (3.08 mm Hg; 95% CI, 1.79, 4.37), diastolic BP (2.28; 95% CI, 1.56, 3.00), and mean arterial pressure (2.54 mm Hg; 95% CI, 1.73, 3.36) in both groups.

Conclusions  In this clinic-based effectiveness study involving patients closely followed for BP control, a significant reduction of BP measures (strongest for SBP) was observed in response to CPAP which was similar in RHTN and non-RHTN groups thus informing expected clinical CPAP treatment response.

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