Document Detail


Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial.
MedLine Citation:
PMID:  21106625     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the effect of continuous positive airway pressure (CPAP) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of new onset and obstructive sleep apnoea.
DESIGN: Multicentre, double blind, randomised, placebo controlled trial.
SETTING: Eleven general hospitals in Spain between 2004 and 2007.
PARTICIPANTS: 340 patients recently diagnosed as having systemic hypertension by a general practitioner (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or both) and an apnoea-hypopnoea index per hour of sleep of >15 events/hour.
INTERVENTION: Patients were assigned to CPAP (n=169) or sham CPAP (n=171) for three months. Main outcome measurements Net changes in the different 24 hour ambulatory blood pressure monitoring values from baseline to three months of optimal or sham CPAP.
RESULTS: 277 (81%) of the 340 patients randomised were men; the patients had a mean age of 52.4 (SD 10.5) years, a body mass index of 31.9 (5.7), an Epworth sleepiness scale score of 10.1 (4.3), an apnoea-hypopnoea index of 43.5 (24.5). No differences between groups were seen at baseline. Compared with placebo and analysed by intention to treat, the mean 24 hour ambulatory blood pressure of the CPAP group decreased by 1.5 (95% confidence interval: 0.4 to 2.7) mm Hg (P=0.01). The mean 24 hour ambulatory blood pressure monitoring measures decreased by 2.1 mm Hg (0.4 to 3.7) mm Hg (P=0.01) for systolic pressure and 1.3 (0.2 to 2.3) mm Hg (P=0.02) for diastolic blood pressure. Mean nocturnal blood pressure decreased by 2.1 (0.5 to 3.6) mm Hg (P=0.01).
CONCLUSIONS: CPAP produced a statistically significant reduction in blood pressure in patients with systemic hypertension and obstructive sleep apnoea. This reduction is small and did not achieve the 3 mm Hg drop in mean 24 hour ambulatory blood pressure that the trial was powered to detect. Consequently, these results may have uncertain clinical relevance. However, taking into account the prevalence of hypertension and the likelihood of comorbidities, the decrease in blood pressure, although minimal, may be beneficial.
TRIAL REGISTRATION: Clinical trials NCT00202527.
Authors:
Joaquín Durán-Cantolla; Felipe Aizpuru; Jose María Montserrat; Eugeni Ballester; Joaquín Terán-Santos; Jose Ignacio Aguirregomoscorta; Mónica Gonzalez; Patricia Lloberes; Juan Fernando Masa; Mónica De La Peña; Santiago Carrizo; Mercedes Mayos; Ferrán Barbé;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-11-24
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  341     ISSN:  1756-1833     ISO Abbreviation:  BMJ     Publication Date:  2010  
Date Detail:
Created Date:  2010-11-25     Completed Date:  2010-12-13     Revised Date:  2012-03-06    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  England    
Other Details:
Languages:  eng     Pagination:  c5991     Citation Subset:  AIM; IM    
Affiliation:
Sleep Unit, Hospital Universitario Txagorritxu, Facultad de Medicina, Universidad del País Vasco, Vitoria 01009, Spain. joaquin.durancantolla@gmail.com
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00202527
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Blood Pressure / physiology
Blood Pressure Monitoring, Ambulatory
Continuous Positive Airway Pressure / methods*
Double-Blind Method
Female
Humans
Hypertension / complications,  physiopathology,  therapy*
Male
Middle Aged
Polysomnography
Sleep Apnea, Obstructive / complications,  physiopathology,  therapy*
Young Adult
Investigator
Investigator/Affiliation:
Amanda López-Picado / ; Erika Miranda-Serrano / ; Cristina Martinez-Null / ; Ramón Rubio / ; Maria Luz Alonso / ; José Cordero / ; Cristobal Esteban / ; Antonio Jiménez / ; Maria Rosario Carpizo / ; Gabriel Sanpol / ; Jaime Corral / ; Manola Rubio / ; Antonia Barceló / ; Javier Piérola / ; José María Marín /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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