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

Hypertension Research volume 45, pages 1802–1813 (2022)Cite this article

Abstract

This meta-analysis was performed to determine the effects of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with systemic hypertension and obstructive sleep apnea (OSA). A systematic search was conducted using PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials on the treatment of hypertension and OSA with CPAP, compared with sham CPAP or no CPAP, were reviewed. Studies were pooled to obtain weighted mean differences (WMDs) with 95% confidence intervals (CIs). Nineteen trials (enrolling 1904 participants) met the inclusion criteria. CPAP had significant effects on 24-h systolic blood pressure (SBP) (WMD −5.01 mmHg, 95% CI −6.94 to −3.08; P < 0.00001), 24-h diastolic blood pressure (DBP) (WMD −3.30 mmHg, 95% CI −4.32 to −2.28; P < 0.00001), daytime SBP (WMD −4.34 mmHg, 95% CI −6.27 to −2.40; P < 0.0001), daytime DBP (WMD −2.97 mmHg, 95% CI −3.99 to −1.95; P < 0.00001), nighttime SBP (WMD −3.55 mmHg, 95% CI −5.08 to −2.03; P < 0.00001), nighttime DBP (WMD −2.33 mmHg, 95% CI −3.27 to −1.40; P < 0.00001), office SBP (WMD −3.67 mmHg, 95% CI −5.76 to −1.58; P = 0.0006), office DBP (WMD −2.61 mmHg, 95% CI −4.25 to −0.97; P = 0.002), and heart rate (WMD −2.79 beats/min, 95% CI −4.88 to −0.71; P = 0.009). CPAP treatment was associated with BP reduction in patients with systemic hypertension and OSA, except when the follow-up period was shorter than 3 months.

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References

  1. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.

    Article  PubMed  CAS  Google Scholar 

  2. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–5.

    PubMed  CAS  Google Scholar 

  3. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72:e53–90.

    Article  PubMed  CAS  Google Scholar 

  4. Rimoldi SF, Messerli FH, Bangalore S, Scherrer U. Resistant hypertension: what the cardiologist needs to know. Eur Heart J. 2015;36:2686–95.

    Article  PubMed  Google Scholar 

  5. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–7.

    Article  PubMed  CAS  Google Scholar 

  6. Gonçalves SC, Martinez D, Gus M, de Abreu-Silva EO, Bertoluci C, Dutra I, et al. Obstructive sleep apnea and resistant hypertension: a case-control study. Chest. 2007;132:1858–62.

    Article  PubMed  Google Scholar 

  7. Foster GE, Hanly PJ, Ahmed SB, Beaudin AE, Pialoux V, Poulin MJ. Intermittent hypoxia increases arterial blood pressure in humans through a Renin-Angiotensin system-dependent mechanism. Hypertension. 2010;56:369–77.

    Article  PubMed  CAS  Google Scholar 

  8. Fletcher EC, Orolinova N, Bader M. Blood pressure response to chronic episodic hypoxia: the renin-angiotensin system. J Appl Physiol. 2002;92:627–33.

    Article  PubMed  CAS  Google Scholar 

  9. Tamisier R, Gilmartin GS, Launois SH, Pépin JL, Nespoulet H, Thomas R, et al. A new model of chronic intermittent hypoxia in humans: effect on ventilation, sleep, and blood pressure. J Appl Physiol. 2009;107:17–24.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Shang W, Zhang Y, Wang G, Han D. Benefits of continuous positive airway pressure on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea: a meta-analysis. Diabetes Obes Metab. 2021;23:540–8.

    Article  PubMed  CAS  Google Scholar 

  11. Pengo MF, Soranna D, Giontella A, Perger E, Mattaliano P, Schwarz EI, et al. Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis. Eur Respir J. 2020;55:1901945.

    Article  PubMed  Google Scholar 

  12. Muxfeldt ES, Margallo V, Costa LM, Guimarães G, Cavalcante AH, Azevedo JC, et al. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial. Hypertension. 2015;65:736–42.

    Article  PubMed  CAS  Google Scholar 

  13. Durán-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Terán-Santos J, Aguirregomoscorta JI, et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ. 2010;341:c5991.

    Article  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    Article  PubMed  Google Scholar 

  15. Detsky AS, Naylor CD, O’Rourke K, McGeer AJ, L’Abbé KA. Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol. 1992;45:255–65.

    Article  PubMed  CAS  Google Scholar 

  16. Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit care Med. 2010;181:718–26.

    Article  PubMed  Google Scholar 

  17. Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, Merino-Sanchez M, Gonzalez-Benitez MA, Beltran-Robles M, et al. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest. 2006;129:1459–67.

    Article  PubMed  Google Scholar 

  18. Casitas R, Martínez-Cerón E, Galera R, Cubillos-Zapata C, González-Villalba MJ, Fernández-Navarro I, et al. The effect of treatment for sleep apnoea on determinants of blood pressure control. Eur Respir J. 2017;50:1701261.

    Article  PubMed  Google Scholar 

  19. Chen Q, Cheng YB, Shen M, Yin B, Yi HH, Feng J, et al. A randomized controlled trial on ambulatory blood pressure lowering effect of CPAP in patients with obstructive sleep apnea and nocturnal hypertension. Blood Press. 2020;29:21–30.

    Article  PubMed  Google Scholar 

  20. Huang Z, Liu Z, Luo Q, Zhao Q, Zhao Z, Ma X, et al. Long-term effects of continuous positive airway pressure on blood pressure and prognosis in hypertensive patients with coronary heart disease and obstructive sleep apnea: a randomized controlled trial. Am J Hypertens. 2015;28:300–6.

    Article  PubMed  Google Scholar 

  21. Hui DS, To KW, Ko FW, Fok JP, Chan MC, Ngai JC, et al. Nasal CPAP reduces systemic blood pressure in patients with obstructive sleep apnoea and mild sleepiness. Thorax. 2006;61:1083–90.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Joyeux-Faure M, Baguet JP, Barone-Rochette G, Faure P, Sosner P, Mounier-Vehier C, et al. Continuous positive airway pressure reduces night-time blood pressure and heart rate in patients with obstructive sleep apnea and resistant hypertension: the RHOOSAS randomized controlled trial. Front Neurol. 2018;9:318.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Litvin AY, Sukmarova ZN, Elfimova EM, Aksenova AV, Galitsin PV, Rogoza AN, et al. Effects of CPAP on “vascular” risk factors in patients with obstructive sleep apnea and arterial hypertension. Vasc Health Risk Manag. 2013;9:229–35.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Lui MM, Tse HF, Lam DC, Lau KK, Chan CW, Ip MS. Continuous positive airway pressure improves blood pressure and serum cardiovascular biomarkers in obstructive sleep apnoea and hypertension. Eur Respir J. 2021;58:2003687.

    Article  PubMed  CAS  Google Scholar 

  25. Lloberes P, Sampol G, Espinel E, Segarra A, Ramon MA, Romero O, et al. A randomized controlled study of CPAP effect on plasma aldosterone concentration in patients with resistant hypertension and obstructive sleep apnea. J Hypertens. 2014;32:1650–7.

    Article  PubMed  CAS  Google Scholar 

  26. Lozano L, Tovar JL, Sampol G, Romero O, Jurado MJ, Segarra A, et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens. 2010;28:2161–8.

    Article  PubMed  CAS  Google Scholar 

  27. Martínez-García MA, Capote F, Campos-Rodríguez F, Lloberes P, Díaz de Atauri MJ, Somoza M, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. Jama. 2013;310:2407–15.

    Article  PubMed  Google Scholar 

  28. Pedrosa RP, Drager LF, de Paula LKG, Amaro ACS, Bortolotto LA, Lorenzi-Filho G. Effects of OSA treatment on BP in patients with resistant hypertension: a randomized trial. Chest. 2013;144:1487–94.

    Article  PubMed  CAS  Google Scholar 

  29. Robinson GV, Smith DM, Langford BA, Davies RJ, Stradling JR. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J. 2006;27:1229–35.

    Article  PubMed  CAS  Google Scholar 

  30. Ruzicka M, Knoll G, Leenen FHH, Leech J, Aaron SD, Hiremath S. Effects of CPAP on blood pressure and sympathetic activity in patients with diabetes mellitus, chronic kidney disease, and resistant. Hypertension CJC Open. 2020;2:258–64.

    Article  PubMed  Google Scholar 

  31. Thunström E, Manhem K, Rosengren A, Peker Y. Blood pressure response to losartan and continuous positive airway pressure in hypertension and obstructive sleep apnea. Am J Respir Crit Care Med. 2016;193:310–20.

    Article  PubMed  Google Scholar 

  32. Zou B, Guo X, Liu Y, Zou R, Li G, Liu J, et al. Randomized controlled trial of continuous positive airway pressure treatment of resistant hypertensive patients combined with obstructive sleep apnea/hypopnea syndrome. Int J Clin Exp Med. 2018;11:11965–72.

    CAS  Google Scholar 

  33. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.

    Article  PubMed  CAS  Google Scholar 

  34. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.

    Article  PubMed  CAS  Google Scholar 

  35. Gaddam KK, Nishizaka MK, Pratt-Ubunama MN, Pimenta E, Aban I, Oparil S, et al. Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion. Arch Intern Med. 2008;168:1159–64.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Calhoun DA, Nishizaka MK, Zaman MA, Harding SM. Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest. 2004;125:112–7.

    Article  PubMed  CAS  Google Scholar 

  37. de Souza F, Muxfeldt ES, Margallo V, Cortez AF, Cavalcanti AH, Salles GF. Effects of continuous positive airway pressure treatment on aldosterone excretion in patients with obstructive sleep apnoea and resistant hypertension: a randomized controlled trial. J Hypertens. 2017;35:837–44.

    Article  PubMed  Google Scholar 

  38. Palatini P. Role of elevated heart rate in the development of cardiovascular disease in hypertension. Hypertension. 2011;58:745–50.

    Article  PubMed  CAS  Google Scholar 

  39. Reule S, Drawz PE. Heart rate and blood pressure: any possible implications for management of hypertension? Curr Hypertens Rep. 2012;14:478–84.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Telera MP, Pede S, et al. Adverse prognostic value of a blunted circadian rhythm of heart rate in essential hypertension. J Hypertens. 1998;16:1335–43.

    Article  PubMed  CAS  Google Scholar 

  41. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–94.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, PR China

    Wenli Shang, Lu Liu, Guizuo Wang & Dong Han

  2. Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, PR China

    Yingying Zhang

  3. Department of Cadre Health Care, The Second Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, PR China

    Fenfen Chen

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Shang, W., Zhang, Y., Liu, L. et al. Benefits of continuous positive airway pressure on blood pressure in patients with hypertension and obstructive sleep apnea: a meta-analysis. Hypertens Res 45, 1802–1813 (2022). https://doi.org/10.1038/s41440-022-00954-9

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