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

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; I-2 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I-2 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; I-2 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I-2 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.NHLBI of the Ohio State University Center for Clinical and Translational ScienceUniv S Carolina, Div Pulm Crit Care & Sleep Med, Columbia, SC 29208 USAOhio State Univ, Wexner Med Ctr, Div Nephrol, Columbus, OH 43210 USAUniversidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, São Paulo, BrazilUniv Penn, Perelman Sch Med, Renal & Hypertens Div, Philadelphia, PA 19104 USAUniv Penn, Perelman Sch Med, Ctr Sleep & Circadian Neurobiol, Div Sleep Med, Philadelphia, PA 19104 USAUniv Iceland, Sch Hlth Sci, Fac Med, Reykjavik, IcelandCharite, Ctr Sleep Med, Berlin, GermanyRoyal N Shore Hosp, Dept Resp & Sleep Med, St Leonards, NSW 2065, AustraliaUniv Sydney, Woodcock Inst Med Res, Sydney, NSW 2006, AustraliaTaoyuan Chang Gung Mem Hosp, Dept Internal Med, Gueishan Township, TaiwanOhio State Univ, Wexner Med Ctr, Div Pulm Allergy Crit Care & Sleep Med, Columbus, OH 43210 USAUniversidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, São Paulo, BrazilNHLBI of the Ohio State University Center for Clinical and Translational Science: P01 HL094307NHLBI of the Ohio State University Center for Clinical and Translational Science: HL093463NHLBI of the Ohio State University Center for Clinical and Translational Science: UL1TR000090Web of Scienc