Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort

Chest. 2016 Mar;149(3):747-55. doi: 10.1378/chest.15-0697. Epub 2016 Jan 8.


Background: Clinic-based effectiveness studies of sleep-disordered breathing (SDB) treatment in reducing BP in resistant hypertension (RHTN) vs non-RHTN are sparse. We hypothesize that CPAP use in SDB reduces BP significantly in RHTN and non-RHTN in a large clinic-based cohort.

Methods: Electronic medical records were reviewed in patients with SDB and comorbid RHTN and non-RHTN for CPAP therapy initiation (baseline) and subsequent visits. We estimated generalizable BP changes from multivariable mixed-effects linear models for systolic BP (SBP), diastolic BP, and mean arterial pressure, adjusting for RHTN status, age, sex, race, BMI, cardiac history, and diabetes and repeated measure correlation.

Results: Of 894 patients, 130 (15%) had RHTN at baseline (age, 58 ± 12 years; 52% men; BMI, 36 ± 9 kg/m(2)). Patients with RHTN had significantly higher BP overall (P < .001), most notably for SBP (6.9 mm Hg; 95% CI, 3.84, 9.94). In the year following CPAP initiation, improvements in BP indexes did not generally differ based on RHTN status in which RHTN status was a fixed effect. However, there was a significant decrease in SBP (3.08 mm Hg; 95% CI, 1.79, 4.37), diastolic BP (2.28; 95% CI, 1.56, 3.00), and mean arterial pressure (2.54 mm Hg; 95% CI, 1.73, 3.36) in both groups.

Conclusions: In this clinic-based effectiveness study involving patients closely followed for BP control, a significant reduction of BP measures (strongest for SBP) was observed in response to CPAP which was similar in RHTN and non-RHTN groups thus informing expected clinical CPAP treatment response.

Keywords: hypertension; sleep medicine; sleep-disordered.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care Facilities
  • Antihypertensive Agents / therapeutic use*
  • Arterial Pressure*
  • Blood Pressure
  • Case-Control Studies
  • Cohort Studies
  • Comorbidity
  • Continuous Positive Airway Pressure / methods*
  • Female
  • Humans
  • Hypertension / therapy*
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Polysomnography
  • Sleep Apnea Syndromes / epidemiology
  • Sleep Apnea Syndromes / therapy*
  • Treatment Failure
  • Treatment Outcome


  • Antihypertensive Agents