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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn a randomized clinical trial conducted in Spain, blood pressure in patients with resistant hypertension and obstructive sleep apnea was significantly and clinically reduced following treatment with continuous positive airway pressure (CPAP). In those patients with good adherence to CPAP therapy, a significant percentage recovered their normal nocturnal dipper pattern and\/or reversed their riser pattern. This article presents the results of the HIPARCO study (Hipertensi\u00f3n Arterial Resistente Control con CPAP).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary \u0026amp; Critical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn a randomized clinical trial conducted in Spain, blood pressure (BP) in patients with resistant hypertension (RH) and obstructive sleep apnea (OSA) was significantly and clinically reduced following treatment with continuous positive airway pressure (CPAP). In those patients with good adherence to CPAP therapy, a significant percentage recovered their normal nocturnal dipper pattern and\/or reversed their riser pattern. Miguel \u00c1ngel Mart\u00ednez-Garc\u00eda, MD, PhD, University and Polytechnic La Fe Hospital, Valencia, Spain, presented the results of the HIPARCO study (Hipertensi\u00f3n Arterial Resistente Control con CPAP).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe objective of this multicenter study was to evaluate the effect of CPAP treatment on the BP levels and nocturnal BP pattern in patients with OSA and RH. Patients with RH and confirmed OSA were randomly assigned to usual medical therapy (n=96) or medical therapy plus tritated fixed CPAP pressure (n=98) for 12 weeks. Patients with 24-hour BP \u0026gt;130\/85 mm Hg (determined by ambulatory blood pressure monitoring [ABPM]), an apnea-hypopnea index \u0026gt;15, and with at least an 80% adherence to antihypertensive drug treatment were included in the study. The prevalence of OSA was 82.7% in this population. Patients were monitored at 2, 4, 8, and 12 weeks for CPAP and antihypertensive drug adherence, changes in body mass index (BMI), and new cardiovascular (CV) events. At the 12-week visit, patients underwent a second 24-hour ABPM. All randomized patients independent of their use or not of CPAP were included in the intention-to-treat (ITT) analysis and those patients with a good adherence to CPAP (\u22654 hours of CPAP; 68% of randomized patients) use were included in the per protocol (PP) analysis.\u003C\/p\u003E\u003Cblockquote id=\u0022disp-quote-1\u0022 class=\u0022disp-quote\u0022\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIncreasing evidence suggests a relationship between visceral adipose tissue dysfunction and the pathophysiology of COPD.\u003C\/p\u003E\n      \u003C\/blockquote\u003E\u003Cp id=\u0022p-5\u0022\u003EDemographics and baseline characteristics were similar in both treatment groups. Mean BMI was 34.1\u00b15.4 kg\/m\u003Csup\u003E2\u003C\/sup\u003E; mean number of antihypertensive drug used was 3.8\u00b10.9; 21.4% of participants had past CV events; mean 24-hour BP was 144.2\u00b112.5\/83.0\u00b110.5 mm Hg. More than 70% of patients had a nondipper (42.8%) or a riser nocturnal (31.4%) BP pattern. Almost 95% of the patients were on diuretics.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the ITT analysis, the use of CPAP significantly reduced diastolic (p=0.005) and mean BP (p=0.016) compared with the control group and was associated with a near-significant reduction in 24-hour systolic BP (p=0.09). The reductions (about 3 mm Hg), were clinically relevant. In the PP analysis (only those patients with good CPAP compliance), CPAP use significantly decreased systolic BP, diastolic BP, and mean BP by 4 to 5 mm Hg (p=0.01, p=0.001, and p=0.001, respectively).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe decreases in BP levels were more pronounced during the night especially in those patients with better tolerance to CPAP.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe probability of recovering the dipper pattern and reversing the riser pattern was significantly greater (p\u22640.03) in both the ITT and PP analysis in those patients allocated to the CPAP arm. Moreover there was a positive and linear relationship between the number of hours of CPAP use and the decrease in 24-hour BP values, both BP diurnal and nocturnal values. The presence or absence of daytime hypersomnolence, sex, age, years from RH diagnosis and BMI had no impact on treatment effectiveness.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Mart\u00ednez-Garc\u00eda would like to see future long-term studies that analyze the effect of CPAP on the incidence of CV events or death and BP treatment in these patients with RH and OSA.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/4\/20.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznxhp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}