Home blood pressure monitoring completion rates and continuous positive airway pressure adherence during the first six months following CPAP initiation: An exploratory, observational study.
The use of HBPM device decreased regardless the patients' clinical phenotype, whereas adherence to CPAP increased slightly suggesting a limited interaction between the use of the two connected devices.
Abstract
OBJECTIVE/
Background
Home blood pressure monitoring (HBPM) has become the standard of care for diagnosing hypertension - the most prevalent comorbidity of obstructive sleep apnea (OSA) - and for monitoring blood pressure response to treatment. Connected devices have been used in recent studies to monitor blood pressure in patients with OSA initiated on continuous positive airway pressure (CPAP). We compared the respective evolution of HBPM completion rate and CPAP adherence rate in the first six months of treatment.
PATIENTS/
Methods
98 patients were prospectively included, and were asked to record 6 daily HBPM measurements. CPAP adherence was obtained using telemonitoring. HBPM completion rates and CPAP adherence rates were monthly calculated. A Mann- Kendall test was performed to describe the changes in rates and adjusted linear mixed models were used to assess the association between these two rates.
Results
HBPM completion rate significantly decreased from 44% during the 1st month to 19% at six months. CPAP adherence rate significantly increased from 35% the 1st month to 41% at six months. A similar decrease of HBPM completion rate was shown among different patients' profiles. Linear mixed models showed that an increase in CPAP adherence rates of 1% was associated with an increase in HBPM completion rates of 0.17% [0.08; 0.25].
Conclusion
The use of HBPM device decreased regardless the patients' clinical phenotype, whereas adherence to CPAP increased slightly. The positive association between the two rates was modest and non-clinically significant suggesting a limited interaction between the use of the two connected devices.
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each, supporting shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
Frances M Wang, Hannah V Col, F. L. Kwapong et al.· American Journal of Hyperten...· 0 citations
Background: Obstructive sleep apnea (OSA) is a common sleep disorder associated with increased cardiovascular morbidity. Continuous positive airway pressure (CPAP) therapy is the standard treatment; however, its long-term cardiovascular benefits remain uncertain. Aim: To evaluate 5-year associations between CPAP therapy and the risks of cardiovascular diseases in patients with OSA. Methods: This retrospective cohort study used the TriNetX global database, including adults diagnosed with OSA between 2014 and 2025. Patients with prior cardiovascular disease were excluded. After 1:1 propensity score matching, 54,635 CPAP users were compared to matched nonusers. Participants were followed from 1 day to 5 years after the index date. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for incident cardiovascular outcomes. Sensitivity analyses were performed at 1- and 3-month follow-up thresholds. Results: CPAP therapy was associated with significantly lower risks of stroke (HR 0.861), transient ischemic attack (HR 0.699), atrial fibrillation/flutter (HR 0.781), bradycardia (HR 0.899), ventricular arrhythmias (HR 0.875), pericarditis (HR 0.768), angina (HR 0.619), major adverse cardiovascular events (HR 0.936), and cardiac conduction and functional disorders (HR 0.861). No significant risk reduction was observed for pulmonary embolisms, deep vein thromboses, myocardial infarction, or structural cardiac abnormalities. Sensitivity analyses confirmed the robustness of most findings. Conclusions: In patients with OSA, CPAP therapy was associated with reduced risks of several cardiovascular outcomes over 5 years, although benefits were not observed across all conditions. These findings highlight the potential but selective cardiovascular benefits of CPAP therapy, warranting further prospective and randomized studies.
V. L. Amelia, Septi Melisa, Jason C. Hsu et al.· Biological Research for Nurs...· 0 citations
BACKGROUND
Positive airway pressure (PAP) has shown inconsistent effects on cardiovascular (CV) outcomes in obstructive sleep apnoea (OSA). Physiological biomarkers derived from sleep studies such as sleep apnoea-specific hypoxic burden (SASHB) and event-related heart rate response (ΔHR) may help identify OSA patients with modifiable CV risk.
METHODS
3370 PAP-treated moderate-to-severe OSA patients, from the Pays de la Loire sleep-clinic cohort linked to the French health database (SNDS), were stratified by a high-risk status defined by SASHB >40.6%·min·h⁻1 or ΔHR >21.7 bpm, using percentile-based approach for threshold estimation. The primary composite outcome was defined using the first occurrence in SNDS of major adverse CV event (MACE). Cox models assessed the association between PAP adherence (mean PAP use ≥4 h/night) and MACE occurrence.
RESULTS
Over a median follow-up of 9 years, 740 patients experienced a MACE. PAP adherence versus non-adherence was associated with a reduced risk of MACE (adjusted hazard ratio [HR] 0.53, 95% CI [0.46-0.62], p<0.001), but the association was greater in patients with (71.7%) versus without (28.3%) high risk status (interaction HR 0.61 [0.43-0.87]; interaction p value =0.006). Similar findings were obtained using a simplified version of SASHB and ΔHR automatically derived from the single oximetry signal. The interaction of high-risk status between PAP adherence and MACE appeared stronger in non-sleepy patients.
CONCLUSIONS
In sleep-clinic, the association of PAP adherence with reduced MACE risk was stronger in high risk OSA. These findings support the integration of hypoxic and autonomic biomarkers into clinical decision pathways for CV risk reduction in OSA.
S. Bailly, M. Blanchard, A.V. Benjafield et al.· European Respiratory Journal· 0 citations
Aims: Hypertension (HT) remains a major global health problem, and achieving optimal blood pressure (BP) control continues to be challenging in clinical practice. Patient-related factors such as disease awareness, medication adherence, and home blood pressure monitoring (HBPM) behaviors play a crucial role in HT management. This study aimed to evaluate the relationship between these factors and BP control.Methods: This prospective, single-center, cross-sectional study included 280 adult patients with HT. Disease awareness was assessed using the Hypertension Knowledge-Level Scale (HK-LS), and medication adherence was evaluated using the Adherence to Refills and Medications Scale (ARMS). HBPM habits were assessed using a structured questionnaire. Multivariable logistic regression analysis was performed to identify independent predictors of uncontrolled HT. Model performance was evaluated using receiver operating characteristic analysis, calibration plots, and decision curve analysis.Results: A total of 280 patients were analyzed, of whom 132 (47.1%) had uncontrolled HT. Patients with uncontrolled HT had significantly lower HK-LS scores and higher ARMS scores (p
M. Karamanlıoğlu· Journal of Health Sciences a...· 0 citations
BACKGROUND
Nocturnal blood pressure patterns reflect autonomic and volume-related stress and may affect outcomes after pulmonary vein isolation (PVI). We examined their association with atrial fibrillation recurrence after PVI using ambulatory blood pressure monitoring (ABPM).
METHODS AND RESULTS
We retrospectively studied 74 consecutive patients with preprocedural ABPM. Patients were classified as dipper (≥10% nocturnal systolic blood pressure decline), nondipper (0 to <10%), or riser (nighttime > daytime blood pressure). Recurrence was defined as any documented atrial tachyarrhythmia lasting greater than or equal to 30 s after the 90-day blanking period; episodes beginning during blanking and persisting beyond day 90 were assigned to day 90. Recurrence occurred in 27 patients (36.5%). Pattern distribution differed significantly by recurrence status (P = 0.002), with recurrence rates of 26.1% in dippers, 31.0% in nondippers, and 88.9% in risers. Kaplan-Meier analysis showed significantly lower freedom from recurrence in risers (log-rank P < 0.001). In univariable Cox analysis using dippers as the reference, risers were associated with recurrence (hazard ratio: 9.50, 95% confidence interval: 3.22-27.97; P < 0.001), whereas nondippers were not. In an exploratory multivariable model including nocturnal blood pressure pattern, persistent atrial fibrillation, and age, the riser pattern remained associated with recurrence (hazard ratio: 9.53, 95% confidence interval: 3.00-30.29; P < 0.001).
CONCLUSION
The riser pattern on ABPM was associated with early postblanking recurrence after PVI and may provide complementary information for risk stratification.
Rie Aoyama, T. Uchiyama, Tomohiko Hayashi et al.· Blood Pressure Monitoring· 0 citations
The results of the CareBP study show the extended value of 14 days of individual blood pressure monitoring and underline the relevance of this approach for cardiovascular disease prevention.
