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Canadian Journal of Cardiology

Predictors of Blood Pressure Fall With Continuous Positive Airway Pressure Treatment in Hypertension With Coronary Artery Disease and Obstructive Sleep Apnea

  • Zhiwei Huang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Zhihong Liu
    Correspondence
    Corresponding author: Dr Zhihong Liu, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China. Tel. +86-010-88398196; fax: +86-010-88396589.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Qin Luo
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Qing Zhao
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Zhihui Zhao
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Xiuping Ma
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Qunying Xi
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Dan Yang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Published:September 25, 2014DOI:https://doi.org/10.1016/j.cjca.2014.09.015

      Abstract

      Background

      The present study aimed to investigate the predictors of changes in blood pressure (BP) with continuous positive airway pressure (CPAP) treatment in hypertensive patients with coronary heart disease (CHD) and obstructive sleep apnea (OSA).

      Methods

      Seventy-one hypertensive patients with CHD and OSA were enrolled in this study. Daytime systolic BP (SBP), diastolic BP (DBP), Epworth Sleepiness Scale (ESS), and anthropometric characteristics were assessed at baseline and follow-up.

      Results

      Sixty-six patients completed the study. The median follow-up period was 36 months (interquartile range, 24-60 months). The mean duration of CPAP application was 4.3 ± 1.2 hours per night. From baseline to follow-up, SBP and DBP were reduced by 5.6 mm Hg (95% confidence interval [CI], 3.0-8.1) and 3.0 mm Hg (95% CI, 0.8-5.3), respectively. Daytime somnolence was significantly improved (ESS, from 9.5 ± 3.4 at baseline to 3.6 ± 2.0 at follow-up; P < 0.001); the mean improvement in ESS was 6.0 (95% CI, 5.1-6.9). Correlation analysis of the fall in mean BP (MBP) showed that baseline MBP, change in ESS, heart rate, and CPAP compliance showed a positive correlation, whereas the baseline body mass index (BMI) and ESS had an inverse relationship. Stepwise multiple linear regression analysis, however, indicated that only baseline BMI, baseline MBP, and CPAP compliance were independently correlated with the fall in MBP.

      Conclusions

      Long-term CPAP treatment reduces BP in hypertensive patients with CHD and moderate/severe OSA; baseline BMI, baseline MBP, and CPAP compliance are independent predictors of the decrease in BP with CPAP treatment in these patients.

      Résumé

      Introduction

      La présente étude avait pour but d’examiner les prédicteurs de changements dans la pression artérielle (PA) par le traitement par ventilation spontanée en pression positive expiratoire continue (CPAP : continuous positive airway pressure) des patients hypertendus souffrant de coronaropathie et d’apnée obstructive du sommeil (AOS).

      Méthodes

      Soixante-et-onze (71) patients hypertendus souffrant de coronaropathie et d’AOS ont été recrutés pour cette étude. La PA systolique (PAS) et la PA diastolique (PAD) diurnes ainsi que l’échelle de somnolence d’Epworth (ESE) et les caractéristiques anthropométriques ont été évaluées au début et durant le suivi.

      Résultats

      Soixante-six (66) patients ont mené à terme l’étude. La durée médiane de suivi a été de 36 mois (intervalle interquartile, 24-60 mois). La durée moyenne de l’utilisation de la CPAP a été de 4,3 ± 1,2 heures par nuit. Entre le début et la période de suivi, la PAS et la PAD ont respectivement diminué de 5,6 mm Hg (intervalle de confiance [IC] à 95 %, 3,0-8,1) et de 3,0 mm Hg (IC à 95 %, 0.8-5,3). La somnolence diurne s’est significativement améliorée (ESE, de 9,5 ± 3,4 au début à 3,6 ± 2,0 durant le suivi; P < 0,001); l’amélioration moyenne selon l’ESE a été de 6,0 (IC à 95 %, 5,1-6,9). L’analyse de corrélation de la baisse de la PA moyenne (PAM) a montré que la PAM initiale, le changement à l’ESE, le rythme cardiaque et l’observance de la CPAP avaient une corrélation positive, tandis que l’indice de masse corporelle (IMC) et l’ESE au début avaient une relation inverse. Cependant, l’analyse séquentielle de régression linéaire multiple a indiqué que seuls l’IMC initial, la PAM initiale et l’observance de la CPAP avaient indépendamment corrélé avec la baisse de la PAM.

      Conclusions

      Le traitement à long terme par CPAP réduit la PA des patients hypertendus souffrant de coronaropathie et d’AOS modérée et grave; l’IMC initial, la PAM initiale et l’observance de la CPAP sont des prédicteurs indépendants de la diminution de la PA de ces patients traités par CPAP.
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