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J Hypertens. 2014 Dec;32(12):2341-50; discussion 2350. doi: 10.1097/HJH.0000000000000372.

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

Author information

1
aDivision of Pulmonary, Critical Care, and Sleep Medicine, University of South Carolina, Columbia, South Carolina bDivision of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA cDisciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil dRenal and Hypertension Division, University of Pennsylvania Perelman School of Medicine eDivision of Sleep Medicine, Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA fFaculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland gCenter of Sleep Medicine, Charité University Hospital, Berlin, Germany hDepartment of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards iWoodcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia jDepartment of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taiwan, Republic of China kDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Abstract

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; I² 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I² 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; I² 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I² 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.

PMID:
25243523
PMCID:
PMC4291165
DOI:
10.1097/HJH.0000000000000372
[Indexed for MEDLINE]
Free PMC Article

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