Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials

Lei, Qiang; Lv, Yunhui; Li, Kai; Ma, Lei; Du, Guodong; Xiang, Yan; Li, Xuqing

doi:10.1590/S1806-37562016000000190

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META-ANALYSIS • J. bras. pneumol. 43 (5) • Sep-Oct 2017 • https://doi.org/10.1590/S1806-37562016000000190 copy

Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate systematically the effects of continuous positive airway pressure (CPAP) on blood pressure in patients with resistant hypertension and obstructive sleep apnea (OSA).

Methods:

The Cochrane Library, PubMed, ScienceDirect, and the Web of Science were searched for studies investigating the effects of CPAP on blood pressure in patients with resistant hypertension and OSA. The selected studies underwent quality assessment and meta-analysis, as well as being tested for heterogeneity.

Results:

Six randomized controlled trials were included in the meta-analysis. The pooled estimates of the changes in mean systolic blood pressure and mean diastolic blood pressure (as assessed by 24-h ambulatory blood pressure monitoring) were −5.40 mmHg (95% CI: −9.17 to −1.64; p = 0.001; I² = 74%) and −3.86 mmHg (95% CI: −6.41 to −1.30; p = 0.00001; I² = 79%), respectively.

Conclusions:

CPAP therapy can significantly reduce blood pressure in patients with resistant hypertension and OSA.

Keywords:
Continuous positive airway pressure; Sleep apnea, obstructive; Hypertension; Meta-analysis

Author	Year	Number of patients	Male gender, %	Mean age ± SD, years	CPAP compliance, h	Type of study	Treatment duration	Method of BP measurement	Country	Jadad score
Muxfeldt et al.⁽¹⁷⁾	2015	46 (CPAP)	37.9	60.8 ± 8.0	4.8	RCT	6 months	ABPM	Brazil	3
		60 (Control)
de Oliveira et al.⁽¹³⁾	2014	24 (CPAP)	58	59.5 ± 7.3	≥ 4	RCT	8 weeks	ABPM	Brazil	4
		23 (Control)
Lloberes et al.⁽¹⁴⁾	2014	27 (CPAP)	72.4	58.7 ± 9.5	5.7 ± 1.5	RCT	3 months	ABPM	Spain	3
		29 (Control)
Pedrosa et al.⁽¹⁸⁾	2013	19 (CPAP)	74	57 ± 2^a	6.01 ± 0.20	RCT	6 months	ABPM	Brazil	3
		16 (Control)
Martínez-García et al.⁽¹⁶⁾	2013	98 (CPAP)	72.4	56.0 ± 9.5	5 ± 1.9	RCT	3 months	ABPM	Spain	3
		96 (Control)
Lozano et al.⁽¹⁵⁾	2010	20 (CPAP)	75.9	59.2 ± 8.7	5.6 ± 1.5	RCT	3 months	ABPM	Spain	3
		21 (Control)

Study	AHI	ESS score	BMI	SBP	DBP
Muxfeldt et al.⁽¹⁷⁾	41 (21)	11 (6)	33.4 (5.3)	129 (16)	75 (12)
de Oliveira et al.⁽¹³⁾	20 (18-31)^b	10 (6-15)^b	29.8 ± 4.4^c	148 ± 17	88 ± 13
Lloberes et al.⁽¹⁴⁾	50.1 ± 20.6	6.76 ± 3.7	31.4 (4.9)	139.2 ± 11.5	80.8 ± 10.8
Pedrosa et al.⁽¹⁸⁾	29 (24-48)^b	10 ± 1c	32 (28-39)^b	162 ± 4	97 ± 2
Martínez-García et al.⁽¹⁶⁾	40.4 (18.9)	9.1 (3.7)	34.1 (5.4)	144.2 (12.5)	83.0 (10.5)
Lozano et al.⁽¹⁵⁾	52.67 ± 21.5	6.14 ± 3.30	30.8 ± 5.0	129 (16)	75 (12)

Subgroup		SBP (as assessed by 24-h ABPM)
Subgroup		No. of studies	Mean net change	95% CI	p; I² (%)
AHI	≥ 30	4	−3.07	−5.50 to −0.65	p = 0.01; I² = 22%
	> 30	2	−9.58	−11.70 to −7.46	p < 0.00001; I² = 0%
Baseline SBP/DBP, mmHg	> 145/85	2	−9.58	−11.70 to −7.46	p < 0.00001; I² = 0%
	< 145/85	4	−3.07	−5.50 to −0.65	p = 0.01; I² = 22%
BMI, kg/m²	≥ 32	3	−6.81	−8.55 to −5.08	p < 0.00001; I² = 89%
	< 32	3	−6.47	−10.53 to −2.42	p = 0.002; I² = 0%
CPAP compliance, h	> 5	4	−7.47	−9.18 to −5.76	p < 0.00001; I² = 70%
	≤ 5	1	1.20	−4.12 to 6.52	p = 0.66; I² = 0%
Treatment duration, months	> 3	2	−8.03	−10.06 to −6.00	p < 0.00001; I² = 93%
	≤ 3	4	−4.71	−7.29 to −2.12	p = 0.0004; I² = 0%
ESS score	≥ 10	3	−5.89	−13.33 to 1.55	p = 0.12; I² = 85%
	< 10	3	−4.19	−6.92 to −1.47	p = 0.003; I² = 0%
Location	Europe	3	−4.19	-6.92 to −1.47	p = 0.003; I² = 0%
	South America	3	−8.10	−10.07 to −6.13	p < 0.00001; I² = 85%
Study sample size	≥ 25	3	−0.20	−0.41 to −0.01	p = 0.06; I² = 36%
	< 25	3	−0.96	−1.36 to −0.57	p < 0.00001; I² = 88%

Subgroup		DBP (as assessed by 24-h ABPM)
Subgroup		No. of studies	Mean net change	95% CI	p; I² (%)
AHI	≥ 30	4	−2.76	−4.06 to −1.46	p < 0.0001; I² = 64%
	< 30	1	−6.60	−8.17 to −5.03	p < 0.00001; I² = 0%
Baseline SBP/DBP, mmHg	> 145/85	1	−6.60	−8.17 to −5.03	p < 0.00001; I² = 0%
	< 145/85	4	−2.76	−4.06 to −1.46	p < 0.0001; I² = 64%
BMI, kg/m²	≥ 32	3	−4.24	−5.32 to −3.15	p < 0.00001; I² = 91%
	< 32	2	−4.79	−7.39 to −2.18	p = 0.0003; I² = 0%
CPAP compliance, h	> 5	4	−5.18	−6.28 to −4.09	p < 0.00001; I² = 55%
	≤ 5	1	0.30	−2.23 to 2.83	p = 0.82; I² = 0%
Treatment duration, months	> 3	2	−4.67	−6.00 to −3.33	p < 0.00001; I² = 95%
	≤ 3	3	−3.87	−5.39 to −3.35	p < 0.00001; I² = 0%
ESS score	≥ 10	2	−4.67	−6.00 to −3.33	p < 0.00001; I² = 95%
	< 10	3	−3.87	−5.39 to −2.35	p < 0.00001; I² = 0%
Location	Europe	3	−3.87	−5.39 to −2.35.	p < 0.00001; I² = 0%
	South America	2	−4.67	−6.00 to −3.33	p < 0.00001; I² = 95%
Study sample size	≥ 25	3	−2.53	−3.89 to −1.16	p = 0.0003; I² = 72%
	< 25	2	−6.40	−7.88 to −4.93	p < 0.00001; I² = 0%

Explanatory variable	SBP		DBP
Explanatory variable	No. of studies	p	No. of studies	p
ESS score	6	0.74	5	0.44
BMI	6	0.14	5	0.25
AHI	6	0.22	5	0.70
Age	6	0.47	5	< 0.0001

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[1] Correspondence to: Ma Lei. Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Xinzi Building, room 109, Kunming, Yunnan, China. Tel.: 86 13208809503. E-mail: roy_murray@qq.com