Treatment with CPAP therapy in patients with obstructive sleep apnea was associated with a lower risk of incident hypertension compared to controls without OSA (HR 0.71; 95% CI 0.53-0.94).
Cohort (n=1,889)
No
Does CPAP therapy reduce the incidence of new-onset hypertension in patients with obstructive sleep apnea?
Treatment of obstructive sleep apnea with CPAP is associated with a lower risk of incident hypertension compared to untreated OSA.
Effect estimate: HR 0.71 (95% CI 0.53-0.94)
Absolute Event Rate: 3.06% vs 2.19%
CONTEXT: Systemic hypertension is prevalent among patients with obstructive sleep apnea (OSA). Short-term studies indicate that continuous positive airway pressure (CPAP) therapy reduces blood pressure in patients with hypertension and OSA. OBJECTIVE: To determine whether CPAP therapy is associated with a lower risk of incident hypertension. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study of 1889 participants without hypertension who were referred to a sleep center in Zaragoza, Spain, for nocturnal polysomnography between January 1, 1994, and December 31, 2000. Incident hypertension was documented at annual follow-up visits up to January 1, 2011. Multivariable models adjusted for confounding factors, including change in body mass index from baseline to censored time, were used to calculate hazard ratios (HRs) of incident hypertension in participants without OSA (controls), with untreated OSA, and in those treated with CPAP therapy according to national guidelines. MAIN OUTCOME MEASURE: Incidence of new-onset hypertension. RESULTS: During 21,003 person-years of follow-up (median, 12.2 years), 705 cases (37.3%) of incident hypertension were observed. The crude incidence of hypertension per 100 person-years was 2.19 (95% CI, 1.71-2.67) in controls, 3.34 (95% CI, 2.85-3.82) in patients with OSA ineligible for CPAP therapy, 5.84 (95% CI, 4.82-6.86) in patients with OSA who declined CPAP therapy, 5.12 (95% CI, 3.76-6.47) in patients with OSA nonadherent to CPAP therapy, and 3.06 (95% CI, 2.70-3.41) in patients with OSA and treated with CPAP therapy. Compared with controls, the adjusted HRs for incident hypertension were greater among patients with OSA ineligible for CPAP therapy (1.33; 95% CI, 1.01-1.75), among those who declined CPAP therapy (1.96; 95% CI, 1.44-2.66), and among those nonadherent to CPAP therapy (1.78; 95% CI, 1.23-2.58), whereas the HR was lower in patients with OSA who were treated with CPAP therapy (0.71; 95% CI, 0.53-0.94). CONCLUSION: Compared with participants without OSA, the presence of OSA was associated with increased adjusted risk of incident hypertension; however, treatment with CPAP therapy was associated with a lower risk of hypertension.
Marı́n et al. (2012) conducted a cohort in Obstructive sleep apnea (n=1,889). Continuous positive airway pressure (CPAP) therapy vs. Participants without OSA (controls) and untreated OSA was evaluated on Incidence of new-onset hypertension (HR 0.71, 95% CI 0.53-0.94). Treatment with CPAP therapy in patients with obstructive sleep apnea was associated with a lower risk of incident hypertension compared to controls without OSA (HR 0.71; 95% CI 0.53-0.94).