title: Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort.
abstract: BACKGROUND
  Clinic-based effectiveness studies of sleep-disordered breathing (SDB) treatment in reducing BP in resistant hypertension (RHTN) vs non-RHTN are sparse. We hypothesize that CPAP use in SDB reduces BP significantly in RHTN and non-RHTN in a large clinic-based cohort.
  
  
  METHODS
  Electronic medical records were reviewed in patients with SDB and comorbid RHTN and non-RHTN for CPAP therapy initiation (baseline) and subsequent visits. We estimated generalizable BP changes from multivariable mixed-effects linear models for systolic BP (SBP), diastolic BP, and mean arterial pressure, adjusting for RHTN status, age, sex, race, BMI, cardiac history, and diabetes and repeated measure correlation.
  
  
  RESULTS
  Of 894 patients, 130 (15%) had RHTN at baseline (age, 58 ± 12 years; 52% men; BMI, 36 ± 9 kg/m(2)). Patients with RHTN had significantly higher BP overall (P < .001), most notably for SBP (6.9 mm Hg; 95% CI, 3.84, 9.94). In the year following CPAP initiation, improvements in BP indexes did not generally differ based on RHTN status in which RHTN status was a fixed effect. However, there was a significant decrease in SBP (3.08 mm Hg; 95% CI, 1.79, 4.37), diastolic BP (2.28; 95% CI, 1.56, 3.00), and mean arterial pressure (2.54 mm Hg; 95% CI, 1.73, 3.36) in both groups.
  
  
  CONCLUSIONS
  In this clinic-based effectiveness study involving patients closely followed for BP control, a significant reduction of BP measures (strongest for SBP) was observed in response to CPAP which was similar in RHTN and non-RHTN groups thus informing expected clinical CPAP treatment response.
authors.affiliation: Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH. Electronic address: waliah@ccf.org.
authors.forename: Harneet K
authors.initials: HK
authors.lastname: Walia
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Griffith
authors.affiliation: Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Nancy
authors.initials: N
authors.lastname: Foldvary-Schaefer
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH.
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH.
authors.forename: Emmanuel L
authors.initials: EL
authors.lastname: Bravo
authors.affiliation: Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Moul
authors.affiliation: Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehra
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D062186:Arterial Pressure; D001794:Blood Pressure; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000628:therapy*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: hypertension; sleep medicine; sleep-disordered