Obstructive Sleep Apnoea-Hypopnoea Treatment Reduces Blood Pressure in Patients With Systemic Hypertension: Presented at ERS

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Title: Obstructive Sleep Apnoea-Hypopnoea Treatment Reduces Blood Pressure in Patients With Systemic Hypertension: Presented at ERS
URL: http://www.pslgroup.com/dg/22E3EE.htm
Doctor's Guide
October 6, 2008

By Chris Berrie

BERLIN -- October 6, 2008 -- Optimal treatment with continuous positive airway pressure (CPAP) significantly reduces blood pressure in patients with recently diagnosed systemic hypertension and obstructive sleep apnoea-hypopnoea (OSAH), according to a multicentre, randomised, prospective, placebo-controlled, study.

Principal investigator Joaquin Duran-Cantolla, MD, PhD, Department of Respiratory Medicine, Txagorritxu Hospital, Vitoria, Spain, presented this study on October 5 here at the European Respiratory Society (ERS) 18th Annual Congress.

Previous research has shown that OSAH is associated with systemic hypertension, and the apnoea-hypopnoea index (AHI) is an independent risk factor for systemic hypertension.

Dr. Duran-Cantolla and colleagues conducted their large, multicentre trial to determine if CPAP can reduce blood pressure in patients with OSAH who were recently diagnosed as having systemic hypertension.

Enrolled patients were 18 to 75 years old and were habitual snorers with recently diagnosed systemic hypertension and an AHI of 15 or greater. The study excluded treatment for hypertension or depression, heart, liver, or kidney failure, and previous OSAH or CPAP treatment.

The researchers randomised 135 patients to sham CPAP treatment and 138 to optimal CPAP treatment for 12 weeks. Mean age of patients in the 2 groups was 52.3 and 53.1 years, respectively, and 84.1% and 80.6% were male, respectively.

Patients' baseline characteristics across the sham and CPAP treatment groups were not significantly different, including Epworth S scale (9.9 and 10.4, respectively), AHI (43.1 and 43.0, respectively), and diurnal and nocturnal systolic blood pressure (SBP), and diastolic blood pressure (DBP).

After 12 weeks of treatment, the sham CPAP group had no significant changes in SBP or DBP, while patients in the optimal CPAP group had significant improvements in SBP (diurnal, -2.7 mm Hg; P = .001; nocturnal, -4.6 mm Hg; P < .001) and DBP (diurnal, -1.5 mm Hg; P = .006; nocturnal, -2.7 mm Hg; P < .001).

This effect provided a significant increase in dipper status from baseline to 12 weeks for patients under optimal CPAP (30% vs 41%, respectively; P = .024), with no significant change seen for sham CPAP (34% vs 38%; P = .392).

Similarly, at 12 weeks, patients under optimal CPAP treatment had significant improvements over sham treatment for maximum nocturnal SBP and DBP (-4.2 mm Hg, P = .020; -4.3 mm Hg, P < .001), average nocturnal SBP and DBP (-3.5 mm Hg, P = .008; -1.9 mm Hg, P = .027), and average SBP and DBP (-2.4 mm Hg, P = .016; -1.6 mm Hg; P = .019).

This provided a significant global blood pressure reduction of 1.9 mm Hg for the optimal CPAP group over the sham CPAP group (P = .010). The researchers also noted that from baseline blood pressure values, 25% of patients with systemic hypertension in the optimal CPAP group were rated as normal after 12 weeks of treatment.

Dr. Duran-Cantolla said, "Our advice is serious consideration for CPAP treatment in patients with systemic hypertension and obstructive sleep apnoea, regardless of symptoms or not."

He also added that "for the future we also need to identify who is going to respond and who won't."

[Presentation title: CPAP Treatment Reduces Blood Pressure in Patients With Recent Diagnosis of Systemic Hypertension and Obstructive Sleep Apnoea-Hypopnoea (OSAH): A Controlled Study. Abstract P780]

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