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

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/m(2) [25%-75%, 28-39 kg/m(2)]; 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 (Delta : + 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 (Delta: +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.