Comparative Efficacy of Continuous Positive Airway Pressure and Antihypertensive Medications in Obstructive Sleep Apnea-Related Hypertension: A Narrative Review

Abstract

Introduction: Obstructive sleep apnea (OSA) presents a significant global health concern, affecting a substantial portion of the population, particularly among young and middle-aged adults.

Aim: This review aims to assess the efficacy of continuous positive airway pressure (CPAP) compared to antihypertensive medications in managing OSA-related hypertension.

Methods: A comprehensive literature search was conducted across multiple databases, yielding studies published from 2000 to March 2024 that investigated CPAP, antihypertensives, or their combination therapy in OSA patients. Six definitive studies were analyzed, including two randomized controlled trials (RCTs), one randomized double-blind placebo-controlled crossover trial, one placebo-controlled trial, one open-label multicenter trial, and one longitudinal cohort study. These studies comprised 939 participants, with intervention durations ranging from four weeks to six months.

Results: Analysis of CPAP monotherapy revealed variable efficacy, with some studies demonstrating significant reductions in 24-hour mean blood pressure and diastolic pressure, while others reported non-significant changes. CPAP therapy combined with antihypertensives showed additive effects, particularly in reducing office blood pressure measurements. Antihypertensive medications, such as valsartan, exhibited superior efficacy in reducing blood pressure compared to CPAP alone. Factors influencing therapy effectiveness included CPAP compliance, patient characteristics, and coexisting comorbidities. Patients with good CPAP adherence experienced greater reductions in blood pressure. The duration of exposure to OSA and the type of hypertension also impacted the therapy response.

Conclusion: While CPAP and antihypertensive medications offer significant benefits in managing hypertension among OSA patients, challenges such as CPAP intolerance and medication side effects exist. Personalized treatment considering individual patient factors is crucial for optimal management.

Keywords: Anti-hypertensives; CPAP; Hypertension; Obesity; Obstructive sleep apnea.