Home Blood Pressure Trajectories during 6 Months of Continuous Positive Airway Pressure Therapy Results from the eMEUSE-SANTE and SLEEPCONNECT Clinical Trials

Rationale: Obstructive sleep apnea (OSA) and hypertension are common comorbidities and are associated with poor prognosis. Blood pressure (BP) trajectories using home BP monitoring after initiation of continuous positive airway pressure (CPAP) therapy for OSA are poorly documented. Objectives: To describe BP trajectories in the first 6 months after CPAP therapy initiation based on repeated longitudinal measurements of home BP, to evaluate the impact of CPAP on morning and evening home BP, and to identify predictors of home BP evolution during CPAP. Methods: This prospective cohort study enrolled patients with OSA. Home BP monitoring was used to assess morning and evening home BP values over a 7-day period at baseline and over the first 6 months after starting CPAP therapy. Results: A total of 98 patients were enrolled, and 36,600 home BP measurements were available for analysis. Morning and evening systolic/diastolic home BP decreased significantly during the first 6 months of CPAP therapy (P, 0.05 vs. baseline). Morning home BP was significantly higher than evening home BP throughout the study (P, 0.01). After adjustment for OSA severity at baseline and CPAP adherence, factors associated with limited home BP response to CPAP were older age, weight gain during CPAP therapy, current smoking, and previous hypertension. Conclusions: CPAP improved home BP trajectories during the first 6 months, but the response was heterogeneous and less marked for morning BP values. Based on the predictors of BP response during CPAP therapy, weight control appears key to the effective management of patients with OSA and hypertension. Clinical trial registered with www.clinicaltrials.gov (NCT04963192 and NCT04054180).