Resistant Hypertension in Chronic Kidney Disease

327

patients are adherent to CPAP treatment, BP control could not be established in
nearly 30% of patients using CPAP treatment for more than 4 h/night [ 40 , 47 ]. Until
recently, no clinical or laboratory parameter has been known to predict the patients
who will respond favorably to CPAP treatment. In a promising study by Torre et al.
[ 51 ], a singular cluster of miRNAs associated with cardiovascular system appeared
to specifically define the patients with RH and OSAS who responded to CPAP with
favorable decreases in mean BP. The measurement of a specific cluster of miRNAs
may enable generation of a predictive screening tool (HIPARCO Score) to predict
the responders.

Table 20.1 Meta-analyses about the role of CPAP on the treatment of HT in patients with OSAS

Study,

reference,

year

Number

of

studies

Sample

size

Change in

SBP, mmHg

(95% CI)

Change in

DBP, mmHg

(95% CI) Note

Bazzano

et al. [ 58 ]

16 818 −2.46

(−4.31 to

−0.62)

−1.83

(−3.05 to

−0.61)

Net reductions in BP not

statistically different

between day- and nighttime

Haentjens

et al. [ 59 ]

12 572 −1.64

(−2.67 to

−0.60)

−1.48

(−2.18 to

−0.78)

Better BP control with

increasing OSAS severity

and CPAP adherence

Alajmi et al.

[ 49 ]

10 587 −1.38

(3.6 to

−0.88)

−1.52

(3.1 to

−0.07)

Nonsignificant

Montesi

et al. [ 60 ]

28 1948 −2.58

(−3.57 to

−1.59)

−2.01

(−2.84 to

−1.18)

Significant reductions in BP

seen in studies with sleepier

patients with more severe

OSAS and higher CPAP

adherence

Hu et al.

[ 61 ]

7 794 −2.32

(−3.65 to

−1.00)

−1.98

(−2.82 to

−1.14)

Better improvement in

nocturnal SBP. Patients

with resistant HT or

receiving antihypertensives

benefited most from CPAP

Liu et al.

[ 62 ]

5 446 −4.78

(−7.95 to

−1.61)

−2.95

(−5.37 to

−0.53)

Included only the studies

performed on patients with

resistant HT. CPAP also

associated with reductions

in nocturnal DBP

Schein et al.

[ 63 ]

16 1166 −4.92

(−8.70 to

−1.14)

(night-time)

−3.46

(−6.75 to

−0.17)

(24-h)

Significant reductions in

mean 24 h BP

[−3.56 mmHg (−6.79 to

−0.33)]

Iftikhar

et al. [ 64 ]

6 329 −7.21

(−9.04 to

−5.38)

−4.99

(−6.01 to

−3.96)

Included only the studies

performed on patients with

resistant HT

Fava et al.

[ 65 ]

29 1820 −2.6 ± 0.6 −2.0 ± 0.4 Higher baseline AHI
associated with greater
mean decrease in systolic
BP
Abbreviations: AHI apnea-hypopnea index, CI confidence interval, DBP diastolic blood pressure,
HT hypertension, SBP systolic blood pressure

20 The Effect of CPAP Therapy on Resistant Hypertension in Obstructive Sleep...