Pneumology Department, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46012, Valencia, Spain.
Respiratory Department, Hospital Valme, IBiS, Seville, Spain.
Curr Hypertens Rep. 2020 Feb 3;22(2):12. doi: 10.1007/s11906-020-1015-y.
This review seeks to present an overview of the recent literature on the importance of CPAP and antihypertensive treatment adherence in blood pressure control of hypertensive patients, especially those with obstructive sleep apnea.
Although it is unquestionable that a good adherence to CPAP and antihypertensive drugs is crucial to improvements in sleep-related symptoms, blood pressure levels (even the modest reductions of 2-2.5 mmHg achieved by CPAP treatment) and future cardiovascular risk, this adherence decreases over time, despite efforts made toward behavioral intervention and monitoring. Curiously, although taking a drug would seem to be easier than the use of CPAP treatment, based on current information, it seems that the compliance with drug treatment in hypertensive subjects is not better than that achieved with CPAP treatment in OSA patients with hypertension. However, some studies have shown some phenotypes of hypertensive and OSA patients with good adherence and better hypertensive effect, such as those with uncontrolled blood pressure (resistant and refractory hypertension), severe forms of sleep apnea, and more sleep-related symptoms, especially a higher degree of diurnal hypersomnia. The positive effect of antihypertensive drugs and CPAP treatment on blood pressure levels depends on the degree of treatment adherence, especially in forms of uncontrolled hypertension, but this adherence decreases over time. Educational programs and new devices are needed to improve adherence to treatment in these patients, along with fuller understanding of the different patterns and phenotypes of non-adherence.
本文旨在综述 CPAP 和降压治疗依从性对高血压患者血压控制的重要性，尤其是对合并阻塞性睡眠呼吸暂停（OSA）的高血压患者。
尽管 CPAP 和降压药物的良好依从性对改善与睡眠相关的症状、血压水平（即使 CPAP 治疗仅降低 2-2.5mmHg）和未来心血管风险至关重要，这一点不容置疑，但这种依从性会随时间而下降，尽管已经采取了行为干预和监测措施。奇怪的是，尽管服用药物似乎比 CPAP 治疗更容易，但根据目前的信息，高血压患者对药物治疗的依从性似乎并不优于 OSA 合并高血压患者对 CPAP 治疗的依从性。然而，一些研究表明，一些高血压和 OSA 患者具有良好的依从性和更好的降压效果，例如血压控制不佳（难治性高血压）、严重的睡眠呼吸暂停形式和更多与睡眠相关的症状，尤其是白天过度嗜睡程度较高的患者。降压药物和 CPAP 治疗对血压水平的积极影响取决于治疗的依从性程度，尤其是在血压控制不佳的情况下，但这种依从性会随时间而下降。需要教育计划和新设备来提高这些患者的治疗依从性，并更充分地了解不同的不依从模式和表型。
