Dados do Trabalho

Título

IMPACT OF PROLONGED USE OF CONTINUOUS POSITIVE PRESSURE IN HIGH AIRWAYS ON PRESSORIC LEVELS OF PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA

Introdução

Obstructive sleep apnea (OSA) is independently associated with poor blood pressure (BP) control, worsening nocturnal descent and target organ damage, and a high prevalence of resistant hypertension (RH).
It is not yet clear whether the use of CPAP (continuous positive pressure in high airways)promotes significant BP reduction. Most studies have evaluated short-term therapeutic response, perhaps insufficient to reduce sympathetic activity and endothelial dysfunction.

Objetivo

To prospectively evaluate changes in ambulatory blood pressure monitoring (ABPM) after prolonged use of CPAP, compared with a control group with moderate to severe OSA and RH.

Métodos

115 patients (38.3% male, mean age 62 [8] years) diagnosed with moderate and severe OSA were divided into 2 groups for use (CPAP group) and non-use of CPAP (Control group). During follow-up, antihypertensive drugs were adjusted by 24-hour ABPM at baseline and at the end of the study.
The median follow-up was 49 months (range 11 to 77 months). The intergroup comparison of BP changes was calculated by the linear model with group allocation as a fixed factor and adjusted by the respective basic BP values. A subanalysis was also performed only in patients with good CPAP adherence and another with those who started the study with uncontrolled ABPM.

Resultados

67 (58.3%) patients were included in the CPAP group and 48 (41.7%) in the control group, 71 (61.7%) diagnosed with severe OSA - both groups (CPAP and Control). Demographic, anthropometric, clinical and laboratory characteristics, with similar mean ABPM values.
After 49 months, there were no significant changes in ABPM comparing the two groups. Control in ABPM increased from 37.5% to 41.7% in the control group and decreased from 37.3% to 31.3% in the CPAP group (p = 0.12), with no significant changes in medication. In the subanalysis only with patients with good CPAP adherence (n = 58), changes in BP were also similar in both groups. Analyzing those who had uncontrolled ABPM at the time of inclusion in the study, the control group (n = 30) showed a linear reduction (p = 0.06) in nocturnal diastolic BP compared with the CPAP group (n = 42).

Conclusões

The use of CPAP in resistant hypertensive patients with moderate and severe OSA had no benefit in blood pressure control.

Palavras-chave

Resistant Hypertyension (RH) Obstructive Sleep Apnea (OSA) ambulatory blood pressure monitoring (ABPM) Continuous Positive Pressure in High Airways (CPAP)