Does CPAP improve hypertension in OSA?

From the Guidelines

CPAP and Hypertension in OSA

Using CPAP (Continuous Positive Airway Pressure) can help improve blood pressure in patients with sleep apnea, as it has been shown to lower systolic blood pressure by 2-5 mmHg and diastolic blood pressure by 1-3 mmHg 1. It is recommended that patients with sleep apnea use CPAP for at least 4-6 hours per night to see significant improvements in blood pressure.

Key Points

• CPAP use can lead to a reduction in blood pressure, with studies showing a decrease in systolic and diastolic blood pressure 1.
• The benefit of CPAP on blood pressure control is variable, but it is likely to improve blood pressure control, especially in patients with resistant hypertension 1.
• CPAP use for 4 or more hours per night is associated with reduced risk for new-onset hypertension or cardiovascular events compared with controls 1.
• The safety of CPAP therapy has been established, and it is associated with primarily mild adverse effects, including nasal congestion, oronasal dryness, mask discomfort, and nocturnal awakenings 1.

Considerations

• Patient compliance with CPAP use is crucial to achieve significant improvements in blood pressure 1.
• The severity of obstructive sleep apnea and the presence of daytime sleepiness can influence the effectiveness of CPAP on blood pressure control 1.
• CPAP may also reduce the need for blood pressure medications, such as ACE inhibitors or beta blockers, in some patients, but it is essential to work with a healthcare provider to determine the best course of treatment and to monitor blood pressure regularly 1.

From the Research

CPAP and Hypertension in OSA

• The use of Continuous Positive Airway Pressure (CPAP) has been studied extensively in relation to its effects on blood pressure in patients with Obstructive Sleep Apnea (OSA) 2, 3, 4, 5, 6.
• Studies have shown that CPAP can lead to reductions in blood pressure, with varying degrees of significance depending on the population and study design.

Reductions in Blood Pressure

• A meta-analysis of 12 randomized controlled trials found that CPAP reduced 24-hour ambulatory mean blood pressure by 1.69 mm Hg 2.
• Another study found that CPAP treatment for 1 month reduced morning diastolic blood pressure and improved Epworth sleepiness scale scores in patients with OSA and coronary heart disease 3.
• A systematic review and meta-analysis of 16 randomized controlled trials found that CPAP resulted in reductions in office systolic and diastolic blood pressure, as well as 24-hour ambulatory blood pressure 4.
• A meta-analysis of 10 randomized controlled trials found that CPAP was associated with changes in 24-hour systolic and diastolic blood pressure, as well as daytime and nighttime blood pressure, in patients with OSA and resistant hypertension 5.
• A randomized controlled trial found that CPAP treatment had a modest effect on 24-hour systolic blood pressure, with a greater effect on nighttime systolic blood pressure 6.

Factors Influencing Blood Pressure Reductions

• The severity of OSA and the effective nightly use of the CPAP device have been found to be associated with greater reductions in blood pressure 2.
• The use of CPAP has been found to lead to reductions in aldosterone secretion, which may contribute to its blood pressure-lowering effects 5.
• The effect of CPAP on blood pressure may be underestimated when using office blood pressure measurements, and ambulatory blood pressure monitoring may be a more accurate method of assessing the effects of CPAP on blood pressure 6.