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Comment & Response |

CPAP and Reduced Blood Pressure—Reply

Miguel Ángel Martínez-García, MD, PhD1; Francisco Campos-Rodriguez, MD, PhD2; Josep-Maria Montserrat, MD, PhD3
[+] Author Affiliations
1Pneumology Service, University and Polytechnic La Fe Hospital, Valencia, Spain
2Pneumology Service, Valme Hospital, Seville, Spain
3Pneumology Service, Hospital Clinic-IDIBAPS, Barcelona, Spain
JAMA. 2014;311(19):2022-2023. doi:10.1001/jama.2014.2676.
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In Reply In the intention-to-treat (ITT) analysis performed in our study, the decrease in mean 24-hour SBP did not reach statistical significance in the unadjusted analysis (P = .10). However, it reached significance (P = .03) in the adjusted analysis. The decrease, which was between 3.1 mm Hg and 3.9 mm Hg in favor of the CPAP group, could be clinically significant and can hardly be attributed to chance.

In addition, recent studies have shown that adequate adherence to CPAP is paramount to achieve a positive effect on cardiovascular outcomes.1,2 For this reason, we analyzed our study not only as ITT, which provides the most robust conclusions, but also per protocol, which provides results for patients adherent to CPAP and conclusions that are closer to clinical reality. The statistical power of our study reinforces the validity of the per-protocol analysis with a decrease in 24-hour mean SBP of 4.9 mm Hg and a 7.1 mm Hg decrease during nighttime.

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May 21, 2014
Alejandro de la Sierra, MD
1Department of Internal Medicine, Hospital Mutua Terrassa, Terrassa, Spain
JAMA. 2014;311(19):2022. doi:10.1001/jama.2014.2673.
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