Efficay of Continuous Positive Airway Pressure for Resistant Hypertension Patients with Obstructive Sleep Apnea: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HANYuan-yuan , MENGFan-hua , ZHANGJun-shi , Zhule Piya Ismail , XUXin-juan , ZHANGXiang-yang ,  CHENYu-lan

Department of Hypertension, the First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

CHENYu-lan, Email: sheliachen@sina.com

Keywords：

Continuous positive airway pressure; Resistant hypertension; Obstructive sleep apnea; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20160066

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Objective To Affiliated systematically review the efficacy of continuous positive airway pressure (CPAP) for resistant hypertension (RH) patients with obstructive sleep apnea (OSA). Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 10, 2015), CBM, CNKI and WanFang Data from inception to March 2016, to collect randomized controlled trials (RCTs) about CPAP for RH patients with OSA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs involving 395 patients were included. The results of meta-analysis showed that: After 3 months of follow-up, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy could significantly reduce the 24 h diastolic blood pressure (DBP), day DBP, night DBP, 24 h diastolic blood pressure (SBP) and night SBP of RH patients with OSA (MD=-4.79, 95%CI -7.39 to -2.18, P=0.000 3; MD=-2.94, 95%CI -4.99 to -0.89, P=0.005; MD=-3.19, 95%CI -5.84 to -0.55, P=0.02; MD=-4.36, 95%CI -7.38 to -1.33, P=0.005; MD=-4.90, 95%CI -8.72, -1.08, P=0.01), but there was no significant difference between the two groups in day SBP. After 6 months of follow-up, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy could significantly reduce the 24 h DBP, day DBP of RH patients with OSA (MD=-4.89, 95%CI -6.76 to -3.02, P<0.000 01; MD=-5.01, 95%CI -9.58 to -0.45, P=0.03), but there were no significant differences between the two groups in night DBP, 24 h SBP, day SBP, and night SBP. Conclusion Current evidence suggests that CPAP on the basis of antihypertensive drug therapy could effectively reduce the DBP and SBP of RH patients with OSA at short-term follow-up, but the long-term effect on SBP is not obvious. Due to limited quality and quantity of the included studies, the above conclusions need to be verified by more high quality studies.

Citation： HANYuan-yuan, MENGFan-hua, ZHANGJun-shi, Zhule Piya Ismail, XUXin-juan, ZHANGXiang-yang, CHENYu-lan. Efficay of Continuous Positive Airway Pressure for Resistant Hypertension Patients with Obstructive Sleep Apnea: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(4): 427-434. doi: 10.7507/1672-2531.20160066 Copy

1.	Calhoun DA, Jones D, Textor S, et al. Resistant hypertension:diagnosis, evaluation, and treatment:a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation, 2008, 117(25):e510-526.
2.	Persell SD. Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension, 2011, 57(6):1076-1080.
3.	de la Sierra A, Segura J, Banegas JR, et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension, 2011, 57(5):898-902.
4.	Roberie DR, Elliott WJ. What is the prevalence of resistant hypertension in the United States? Curr Opin Cardiol, 2012, 27(4):386-391.
5.	Sarafidis PA, Bakris GL. Resistant hypertension:an overview of evaluation and treatment. J Am Coll Cardiol, 2008, 52(22):1749-1757.
6.	Sander GE, Giles TD. Resistant hypertension:concepts and approach to management. Curr Hypertens Rep, 2011, 13(5):347-355.
7.	Calhoun DA, Jones D, Textor S, et al. Resistant hypertension:diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension, 2008, 51(6):1403-1419.
8.	Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000, 342(19):1378-1384.
9.	Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens, 2001, 19(12):2271-2277.
10.	Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease:an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation, 2008, 118(10):1080-1111.
11.	Baguet JP, Barone-Rochette G, Pepin JL. Hypertension and obstructive sleep apnoea syndrome:current perspectives. J Hum Hypertens, 2009, 23(7):431-443.
12.	Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med, 2005, 142(3):187-197.
13.	Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens, 2007, 25(6):1105-1187.
14.	Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet, 2009, 373(9657):82-93.
15.	Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure:an observational study. Lancet, 2005, 365(9464):1046-1053.
16.	Tsioufis C, Kasiakogias A, Thomopoulos C, et al. Managing hypertension in obstructive sleep apnea:the interplay of continuous positive airway pressure, medication and chronotherapy. J Hypertens, 2010, 28(5):875-882.
17.	Butt M, Dwivedi G, Khair O, et al. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol, 2010, 139(1):7-16.
18.	Lloberes P, Sampol G, Espinel E, 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(8):1650-1657.
19.	Furlan AD, Pennick V, Bombardier C, et al. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976), 2009, 34(18):1929-1941.
20.	吴泰相, 刘关键.隐蔽分组(分配隐藏)和盲法的概念、实施与报告.中国循证医学杂志, 2007, 7(3):222-225.
21.	Martínez-García MA, Capote F, Campos-Rodríguez F, 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(22):2407-2415.
22.	Pedrosa RP, Drager LF, de Paula LK, et al. Effects of OSA treatment on BP in patients with resistant hypertension:a randomized trial. Chest, 2013, 144(5):1487-1494.
23.	Lozano L, Tovar JL, Sampol G, et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension:a randomized, controlled trial. J Hypertens, 2010, 28(10):2161-2168.
24.	Muxfeldt ES, Margallo V, Costa LM, 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(4):736-742.
25.	Logan AG, TkacovaR, Perlikowski SM, et al. Refractory hypertension and sleep apnoea:effect of CPAP on blood pressure and baroreflex. Eur Respir J, 2003, 21(2):241-247.
26.	李南方, 汪迎春. 阻塞性睡眠呼吸暂停低通气综合征导致高血压的机制. 医学与哲学, 2013, 34(10):10-11.
27.	Bazzano LA, Khan Z, Reynolds K, et al. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension, 2007, 50(2):417-423.
28.	Haentjens P, Van Meerhaeghe A, Moscariello A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome:evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med, 2007, 167(8):757-764.
29.	Alajmi M, Mulgrew AT, Fox J, et al. Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea:a meta analysis of randomized controlled trials. Lung, 2007, 185(2):67-72.
30.	Montesi SB, Edwards BA, Malhotra A, et al. The effect of continuous positive airway pressure treatment on blood pressure:a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med, 2012, 8(5):587-596.
31.	Robinson GV, Smith DM, Langford BA, et al. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J, 2006, 27(6):1229-1235.
32.	Barbé F, Durán-Cantolla J, Capote F, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med, 2010, 181(7):718-726.

1. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension:diagnosis, evaluation, and treatment:a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation, 2008, 117(25):e510-526.
2. Persell SD. Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension, 2011, 57(6):1076-1080.
3. de la Sierra A, Segura J, Banegas JR, et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension, 2011, 57(5):898-902.
4. Roberie DR, Elliott WJ. What is the prevalence of resistant hypertension in the United States? Curr Opin Cardiol, 2012, 27(4):386-391.
5. Sarafidis PA, Bakris GL. Resistant hypertension:an overview of evaluation and treatment. J Am Coll Cardiol, 2008, 52(22):1749-1757.
6. Sander GE, Giles TD. Resistant hypertension:concepts and approach to management. Curr Hypertens Rep, 2011, 13(5):347-355.
7. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension:diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension, 2008, 51(6):1403-1419.
8. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000, 342(19):1378-1384.
9. Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens, 2001, 19(12):2271-2277.
10. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease:an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation, 2008, 118(10):1080-1111.
11. Baguet JP, Barone-Rochette G, Pepin JL. Hypertension and obstructive sleep apnoea syndrome:current perspectives. J Hum Hypertens, 2009, 23(7):431-443.
12. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med, 2005, 142(3):187-197.
13. Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens, 2007, 25(6):1105-1187.
14. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet, 2009, 373(9657):82-93.
15. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure:an observational study. Lancet, 2005, 365(9464):1046-1053.
16. Tsioufis C, Kasiakogias A, Thomopoulos C, et al. Managing hypertension in obstructive sleep apnea:the interplay of continuous positive airway pressure, medication and chronotherapy. J Hypertens, 2010, 28(5):875-882.
17. Butt M, Dwivedi G, Khair O, et al. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol, 2010, 139(1):7-16.
18. Lloberes P, Sampol G, Espinel E, 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(8):1650-1657.
19. Furlan AD, Pennick V, Bombardier C, et al. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976), 2009, 34(18):1929-1941.
20. 吴泰相, 刘关键.隐蔽分组(分配隐藏)和盲法的概念、实施与报告.中国循证医学杂志, 2007, 7(3):222-225.
21. Martínez-García MA, Capote F, Campos-Rodríguez F, 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(22):2407-2415.
22. Pedrosa RP, Drager LF, de Paula LK, et al. Effects of OSA treatment on BP in patients with resistant hypertension:a randomized trial. Chest, 2013, 144(5):1487-1494.
23. Lozano L, Tovar JL, Sampol G, et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension:a randomized, controlled trial. J Hypertens, 2010, 28(10):2161-2168.
24. Muxfeldt ES, Margallo V, Costa LM, 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(4):736-742.
25. Logan AG, TkacovaR, Perlikowski SM, et al. Refractory hypertension and sleep apnoea:effect of CPAP on blood pressure and baroreflex. Eur Respir J, 2003, 21(2):241-247.
26. 李南方, 汪迎春. 阻塞性睡眠呼吸暂停低通气综合征导致高血压的机制. 医学与哲学, 2013, 34(10):10-11.
27. Bazzano LA, Khan Z, Reynolds K, et al. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension, 2007, 50(2):417-423.
28. Haentjens P, Van Meerhaeghe A, Moscariello A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome:evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med, 2007, 167(8):757-764.
29. Alajmi M, Mulgrew AT, Fox J, et al. Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea:a meta analysis of randomized controlled trials. Lung, 2007, 185(2):67-72.
30. Montesi SB, Edwards BA, Malhotra A, et al. The effect of continuous positive airway pressure treatment on blood pressure:a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med, 2012, 8(5):587-596.
31. Robinson GV, Smith DM, Langford BA, et al. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J, 2006, 27(6):1229-1235.
32. Barbé F, Durán-Cantolla J, Capote F, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med, 2010, 181(7):718-726.

Chinese Journal of Evidence-Based Medicine

Efficay of Continuous Positive Airway Pressure for Resistant Hypertension Patients with Obstructive Sleep Apnea: A Meta-analysis

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