title: Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis.
abstract: OBJECTIVE
  To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).
  
  
  METHODS
  Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.
  
  
  RESULTS
  A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I² 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I² 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I² 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I² 76%), respectively, in favor of the CPAP group.
  
  
  CONCLUSIONS
  The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
authors.affiliation: aDivision of Pulmonary, Critical Care, and Sleep Medicine, University of South Carolina, Columbia, South Carolina bDivision of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA cDisciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil dRenal and Hypertension Division, University of Pennsylvania Perelman School of Medicine eDivision of Sleep Medicine, Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA fFaculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland gCenter of Sleep Medicine, Charité University Hospital, Berlin, Germany hDepartment of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards iWoodcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia jDepartment of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taiwan, Republic of China kDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Iftikhar
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Valentine
authors.forename: Lia R A
authors.initials: LR
authors.lastname: Bittencourt
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Cohen
authors.forename: Annette C
authors.initials: AC
authors.lastname: Fedson
authors.forename: Thorarinn
authors.initials: T
authors.lastname: Gíslason
authors.forename: Thomas
authors.initials: T
authors.lastname: Penzel
authors.forename: Craig L
authors.initials: CL
authors.lastname: Phillips
authors.forename: Lin
authors.initials: L
authors.lastname: Yu-sheng
authors.forename: Allan I
authors.initials: AI
authors.lastname: Pack
authors.forename: Ulysses J
authors.initials: UJ
authors.lastname: Magalang
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000628:therapy*