Among patients with obstructive sleep apnea and hypertension that requires 3 or more medications to control, continuous positive airway pressure (CPAP) treatment for 12 weeks resulted in a decrease in 24-hour average and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern, compared to patients who did not receive CPAP, according to a study appearing in the December 11issue of JAMA.
"Systemic hypertension is one of the most treatable cardiovascular risk factors. Between 12 percent and 27 percent of all hypertensive patients require at least 3 antihypertensive drugs for adequate blood pressure control and are considered patients with resistant hypertension. Patients with resistant hypertension are almost 50 percent more likely to experience a cardiovascular event than hypertensive patients without resistant hypertension, and the incidence of resistant hypertension is expected to increase," according to background information in the article. Recent studies have shown that obstructive sleep apnea [OSA] may contribute to poor control of blood pressure and that a very high percentage (>70 percent) of resistant hypertension patients have OSA. Continuous positive airway pressure is the treatment of choice for severe or symptomatic OSA. "A meta-analysis suggests that CPAP treatment reduces blood pressure levels to a clinically meaningful degree, but whether this positive effect is more pronounced in patients with resistant hypertension is unclear because studies on this issue are scarce and based on single-center approaches."