Effects of CPAP on Central and Peripheral Blood Pressure in Patients with Uncontrolled Hypertension and Obstructive Sleep Apnea: Final Analysis of the Multicenter MORPHEOS Trial

Keywords

hypertension - obstructive sleep apnea - continuous positive airway pressure

Introduction: The impact of obstructive sleep apnea (OSA) treatment with continuous positive airway pressure (CPAP) on central and peripheral blood pressure (BP) is not well established in patients with uncontrolled hypertension (HTN).

Aim: Evaluate the impact of OSA treatment with CPAP on central BP, office BP and 24 hours ambulatory BP monitoring (ABPM).

Methods: The MORPHEOS is a multicenter (n = 6) randomized controlled trial designed to evaluate the BP lowering effects of treatment with CPAP or placebo nasal dilator strips (NDS) for 6-months in adult patients with uncontrolled HTN and moderate-to-severe OSA. Patients using at least one anti-hypertensive medication (AHM) were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24 hours ABPM and ≥ 80% medication adherence evaluated by pill counting after the run-in period (4 weeks). OSA was defined by an apnea-hypopnea index ≥ 15/h. The co-primary endpoints are brachial BP (office and ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage. Visits occur once a week in the first month and once o month thereafter.

Results: One-hundred fourth-five patients with uncontrolled hypertension (median 3 [1.8;4.0] AHM, baseline values of office systolic and diastolic BP: 153 ± 17 and 93 ± 12mmHg, respectively), and OSA were randomized to NDS (n = 72) and CPAP group (n = 73). Due to COVID-19 pandemic and refusals to repeat exams, 22 randomized patients did not complete the study. Baseline clinical and polysomnographic variables were similar between the groups. Compared with NDS, CPAP promoted a greater reduction in SBP and DBP at 6 months (Δ Delta SBP: DNS -4 ± 17 versus CPAP -10 ± 16mmHg, p = 0.027; Δ DBP: NDS -1.27 ± 10 versus CPAP -7 ± 12mmHg, p = 0.004). Regarding central BP, CPAP promoted a greater reduction in central SBP and DBP but did reach statistical significance at 6 months only for DBP (Δ central SBP: NDS -6 ± 19 versus CPAP -10 ± 17mmHg, p = 0.09; Δ central DBP: DNS -3 ± 13 versus CPAP -6 ± 9mmHg, p = 0.006). 24 hours ABPM analysis revealed no differences in BP for the comparisons of NDS and CPAP, but CPAP reduced nighttime heart rate as compared with NDS.

Conclusions: In patients with uncontrolled HTN and OSA under regular AHM, CPAP was effective in reducing office SBP, DBP and central DBP but have no significant effects on ABPM parameters as compared with placebo.

 

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Publikationsverlauf

Artikel online veröffentlicht:
15. Juni 2023