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Positive effect of CPAP treatment on the control of difficult-to-treat hypertension

¹ Pneumology Unit, ² Cardiology Unit, and ³ Service of Internal Medicine, Requena General Hospital, Valencia, Spain.

CORRESPONDENCE: M. A. Martínez-García, Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Paraje Casa Blanca s/n, 43230 Requena, Valencia, Spain. Fax: 34 962336973. E-mail: med013413{at}nacom.es

Keywords: Ambulatory blood pressure monitorisation, continuous positive airway pressure, difficult-to-control hypertension, refractory hypertension, sleep apnoea

Received: April 8, 2006
Accepted January 16, 2007

The aim of the present study was to analyse the role of continuous positive airway pressure (CPAP) treatment in patients with difficult-to-control hypertension (DC-HT) and sleep apnoea.

An Autoset^TM (ResMed, Sydney, Australia) study was performed in 60 patients diagnosed with DC-HT based on two 24-h ambulatory blood pressure monitorisation (ABPM) studies. CPAP was offered to patients with an apnoea/hypopnoea index (AHI) 15 events·h^–1. After 3 months of treatment, repeat ABPM was performed to evaluate the effect of CPAP upon the blood pressure values.

A total of 39 (65%) patients received CPAP treatment, but only 33 completed the study. The mean±SD systolic and diastolic blood pressures (SBP and DBP, respectively) were 154.8±14 and 90±8.8 mmHg. Patients had a mean±SD AHI of 37.7±18.2 events·h^–1. Only three patients presented a dipper nocturnal pressure pattern. CPAP treatment significantly reduced SBP (-5.2 mmHg), and particularly the nocturnal values (-6.1 mmHg), but not DBP. Considering only those patients who tolerated CPAP, the decrease in SBP was greater (-7.3 mmHg). Furthermore, CPAP treatment significantly increased the percentage of patients who recovered the dipper pattern (three (9.1%) out of 33 versus 12 (36.4%) out of 33).

Continuous positive airway pressure treatment significantly reduces systolic blood pressure, particularly at night, and normalises the nocturnal pressure pattern in patients with difficult-to-control hypertension and sleep apnoea.