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Vol. 57. Issue 3.
Pages 165-171 (March 2021)
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Vol. 57. Issue 3.
Pages 165-171 (March 2021)
Original Article
DOI: 10.1016/j.arbr.2019.12.025
Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study
Efecto a largo plazo del tratamiento de la presión positiva continua en las vías respiratorias en eventos cardiovasculares en pacientes con hipertensión resistente y apnea del sueño. Datos del estudio HIPARCO-2
Cristina Navarro-Sorianoa, Miguel-Angel Martínez-Garcíaa,
Corresponding author

Corresponding author.
, Gerard Torresb, Ferrán Barbèc)c,p, Manuel Sánchez-de-la-Torrep,q, Candela Caballero-Erasod,p, Patricia Lloberese,p, Trinidad Díaz Cambrilesf, María Somozag, Juan F. Masah,p, Mónica Gonzálezi, Eva Mañasj, Mónica de la Peñak, Francisco García-Ríol,p, Josep María Montserratm,p, Alfonso Murieln, Grace Osculloa, Alberto García-Ortegaa, Tomás Posadasa, Francisco Campos-Rodríguezo,p, on behalf the Spanish Sleep Network 1
a Pneumology Department, Hospital Universitario y Politèc)cnico La Fe, Valencia, Spain
b Internal Medicine Service, Hospital Universitari de Santa María, Lleida, Spain
c Group of Traslational Research in Respiratory Medicine, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
d Respiratory Department, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS), Seville, Spain
e Respiratory Department, Hospital Universitario Vall Hebrón, Barcelona, Spain
f Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
g Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain
h Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
i Respiratory Department, Hospital Universitario Marquèc)s de Valdecilla, IDIVAL, Santander, Spain
j Respiratory Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
k Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
l Respiratory Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
m Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
n Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain
o Respiratory Department, Hospital Universitario Valme, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain
p Centro de Investigación Biomèc)dica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
q Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
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Tables (3)
Table 1. Characteristics of the patients included and comparisons between those adherent to CPAP treatment and those who were not adherent to (or were not offered) CPAP.
Table 2. Cox regression. Factors associated with the presence of a new cardiovascular event (total number).
Table 3. Cox regression. Factors associated with the presence of a new cardiovascular event (composite or individual).
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Additional material (1)

There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE.


Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3•6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP.


Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96•2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07•15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2•11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05•1.02; p=0.053).


In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.

Cardiovascular events
Resistant hypertension
Coronary heart disease
Cerebrovascular disease
Sleep apnea

Existe cierta controversia sobre el efecto de la presión positiva continua en las vías respiratorias (CPAP) sobre la incidencia de eventos cardiovasculares (ECV). Sin embargo, no se ha evaluado la incidencia de ECV en los pacientes con apnea obstructiva del sueño (AOS) e hipertensión resistente (HR). Nuestro objetivo fue analizar el efecto a largo plazo del tratamiento con CPAP en pacientes con HR y AOS en la incidencia de ECV.


Estudio multicèc)ntrico, observacional y prospectivo de pacientes con AOS y HR. Cada paciente acudió a revisión cada 3-6 meses y se midió la incidencia de ECV. Se compararon los pacientes con buena adherencia a la CPAP (al menos 4h/día) con aquellos con mala adherencia o aquellos a quienes no se les había indicado la CPAP.


Se obtuvieron datos válidos de 163 pacientes con 64 eventos de ECV. Se ofreció tratamiento con CPAP al 82%. Despuèc)s de 58 meses de seguimiento, el 58,3% de los pacientes presentaron buena adherencia a la CPAP. Los pacientes con mala adherencia o sin prescripción de CPAP presentaron un aumento no significativo en la incidencia total de ECV (HR: 1,6; IC 95%: 0,96-2,7; p=0,07). Un análisis de sensibilidad mostró que los pacientes con mala adherencia a la CPAP tuvieron un aumento significativo en la incidencia de eventos cerebrovasculares (HR: 3,1; IC 95%: 1,07-15,1; p=0,041) y crisis hipertensivas (HR: 5,1; IC 95%: 2,2-11,6; p=0,006), pero la tendencia fue en la dirección opuesta con respecto a los eventos coronarios (HR: 0,22; IC 95%: 0,05-1,02; p=0,053).


En pacientes con HR y AOS moderada o grave, un tratamiento ineficaz con CPAP mostró una tendencia hacia un aumento en la incidencia de ECV (particularmente eventos neurovasculares y crisis hipertensivas), sin ningún cambio con respecto a los eventos coronarios.

Palabras clave:
Presión positiva continua en las vías respiratorias
Eventos cardiovasculares
Hipertensión resistente
Accidente cerebrovascular
Enfermedad coronaria
Enfermedad cerebrovascular
Apnea del sueño


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