Long-term effect of obstructive sleep apnea management on blood pressure in patients with resistant hypertension: The SARAH study.

There is a close relationship between obstructive sleep apnea (OSA) and resistant hypertension (RH). However, studies assessing the long-term effect of diagnosing and treating OSA on blood pressure (BP) control in these patients are lacking. To address this gap, we recruited 478 RH patients from hypertension units and followed them prospectively after they were screened for OSA through a sleep study. By performing 24-hour ambulatory BP monitoring (24-h ABPM) annually, the effect of OSA management was assessed. The patients had a median age of 64 [57.2; 69.0] years, 67% were males, and most were nonsleepy, with a median apnea-hypopnea index (AHI) of 15.8 [7.9; 30.7] events/hour. The median follow-up time was 3.01 [2.93; 3.12] years. At baseline, severe OSA was associated with uncontrolled BP, nocturnal hypertension, and a nondipper circadian BP pattern. Moreover, these patients had higher BP values during follow-up than did patients in the other groups. However, among patients with moderate and severe OSA, the management of sleep-disordered breathing, including the implementation of CPAP treatment, was associated with a reduction in 24-h ABPM parameters, especially nighttime BP values, at the one-year follow-up. These benefits were attenuated over time, and only subjects with severe OSA maintained an ABPM nighttime reduction at three years. Furthermore, clinical variables such as uncontrolled BP, sex and age showed a predictive value for the BP response at one year of follow-up. In conclusion, a favorable long-term decrease in BP was detected by diagnosing and treating OSA in a cohort of RH patients from hypertension units, but over time, this decrease was only partially maintained in severe-OSA patients (NCT03002558).