Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Hypertens Res. 2022 Mar;45(3):436-444. doi: 10.1038/s41440-021-00762-7. Epub 2021 Dec 24.
High heterogeneity in the blood pressure (BP) response to continuous positive airway pressure (CPAP) exists in patients with resistant hypertension (RH). Only nondipper normotensive and hypertensive patients exhibited BP reductions when treated with CPAP; the baseline BP dipping pattern has been proposed as a predictor of BP response to CPAP but has never been explored in patients with RH. This study aimed to assess the effect of CPAP on BP in subjects with RH with respect to BP dipping pattern or nocturnal hypertension. This is an ancillary study of the SARAH study. RH subjects with an apnea/hypopnea index (AHI) ≥ 15/h and who received CPAP treatment for 1 year were included. Subjects underwent a sleep study and ambulatory BP monitoring (ABPM) at baseline and at the 1-year follow-up. Eighty-nine RH subjects were included. The subjects were mainly male (77.5%) and obese, with a mean age of 66 years (25th-75th percentile; 59.0; 70.0) and an AHI of 32.7/h (25th-75th percentile; 25.0; 54.7). A total of 68.5% of participants were nondippers, and 71.9% had nocturnal hypertension. After 1 year of CPAP, no significant differences in ABPM parameters were observed between dippers and nondippers. According to nighttime BP, subjects with nocturnal normotension did not show significant changes in ABPM parameters, while nocturnal hypertensive subjects achieved a significant reduction in mean nighttime BP of -4.38 mmHg (-7.10 to -1.66). The adjusted difference between groups was 3.04 (-2.25 to 8.34), which was not significant. This study shows that the BP response to CPAP in patients with RH does not differ according to the BP dipping pattern (dipper and nondipper) and suggests a differential response according to the presence of nocturnal hypertension (ClinicalTrials.gov: NCT03002558).
在患有难治性高血压（RH）的患者中，持续气道正压通气（CPAP）对血压（BP）的反应存在高度异质性。只有非杓型正常血压和高血压患者在用 CPAP 治疗时表现出 BP 降低；基线 BP 杓型模式已被提出作为 CPAP 反应的预测因子，但从未在 RH 患者中进行过探索。本研究旨在评估 CPAP 对 RH 患者 BP 的影响，具体取决于 BP 杓型模式或夜间高血压。这是 SARAH 研究的一项辅助研究。纳入了 AHI≥15/h 并接受 CPAP 治疗 1 年的 RH 患者。患者在基线和 1 年随访时进行了睡眠研究和动态血压监测（ABPM）。共纳入 89 例 RH 患者。患者主要为男性（77.5%）和肥胖，平均年龄 66 岁（25 至 75 百分位数；59.0；70.0），AHI 为 32.7/h（25 至 75 百分位数；25.0；54.7）。共有 68.5%的参与者是非杓型，71.9%有夜间高血压。CPAP 治疗 1 年后，杓型和非杓型患者的 ABPM 参数无显著差异。根据夜间 BP，夜间血压正常的患者 ABPM 参数无明显变化，而夜间高血压患者的平均夜间 BP 显著降低-4.38mmHg（-7.10 至-1.66）。组间调整差异为 3.04（-2.25 至 8.34），无统计学意义。本研究表明，RH 患者对 CPAP 的 BP 反应与 BP 杓型模式（杓型和非杓型）无关，并提示根据夜间高血压的存在存在不同的反应（ClinicalTrials.gov：NCT03002558）。
