Martínez-García M A, Gómez-Aldaraví R, Soler-Cataluña J-J, Martínez T G, Bernácer-Alpera B, Román-Sánchez P
Pneumology Unit, Requena General Hospital, Valencia, Spain.
Eur Respir J. 2007 May;29(5):951-7. doi: 10.1183/09031936.00048606. Epub 2007 Feb 14.
The aim of the present study was to analyse the role of continuous positive airway pressure (CPAP) treatment in patients with difficult-to-control hypertension (DC-HT) and sleep apnoea. An Autoset (ResMed, Sydney, Australia) study was performed in 60 patients diagnosed with DC-HT based on two 24-h ambulatory blood pressure monitorisation (ABPM) studies. CPAP was offered to patients with an apnoea/hypopnoea index (AHI) > or =15 events.h(-1). After 3 months of treatment, repeat ABPM was performed to evaluate the effect of CPAP upon the blood pressure values. A total of 39 (65%) patients received CPAP treatment, but only 33 completed the study. The mean+/-sd systolic and diastolic blood pressures (SBP and DBP, respectively) were 154.8+/-14 and 90+/-8.8 mmHg. Patients had a mean+/-sd AHI of 37.7+/-18.2 events.h(-1). Only three patients presented a dipper nocturnal pressure pattern. CPAP treatment significantly reduced SBP (-5.2 mmHg), and particularly the nocturnal values (-6.1 mmHg), but not DBP. Considering only those patients who tolerated CPAP, the decrease in SBP was greater (-7.3 mmHg). Furthermore, CPAP treatment significantly increased the percentage of patients who recovered the dipper pattern (three (9.1%) out of 33 versus 12 (36.4%) out of 33). Continuous positive airway pressure treatment significantly reduces systolic blood pressure, particularly at night, and normalises the nocturnal pressure pattern in patients with difficult-to-control hypertension and sleep apnoea.
本研究旨在分析持续气道正压通气（CPAP）治疗在难治性高血压（DC-HT）合并睡眠呼吸暂停患者中的作用。对60例经两次24小时动态血压监测（ABPM）确诊为DC-HT的患者进行了一项自动调压（瑞思迈，悉尼，澳大利亚）研究。向呼吸暂停/低通气指数（AHI）≥15次/小时的患者提供CPAP治疗。治疗3个月后，进行重复ABPM以评估CPAP对血压值的影响。共有39例（65%）患者接受了CPAP治疗，但只有33例完成了研究。收缩压和舒张压的平均值±标准差（分别为SBP和DBP）为154.8±14 mmHg和90±8.8 mmHg。患者的平均±标准差AHI为37.7±18.2次/小时。只有3例患者呈现勺型夜间血压模式。CPAP治疗显著降低了SBP（-5.2 mmHg），尤其是夜间值（-6.1 mmHg），但未降低DBP。仅考虑那些耐受CPAP的患者，SBP的下降幅度更大（-7.3 mmHg）。此外，CPAP治疗显著增加了恢复勺型模式的患者比例（33例中有3例（9.1%），而33例中有12例（36.4%））。持续气道正压通气治疗可显著降低收缩压，尤其是夜间收缩压，并使难治性高血压合并睡眠呼吸暂停患者的夜间血压模式正常化。
