Abstract 4370101: Optimizing Cardiovascular Outcomes in Hypertensive Patients with Obstructive Sleep Apnea: A Systematic Review of CPAP and Adjunctive Therapies

Abstract

Background: Obstructive sleep apnea (OSA) is frequently found in individuals with hypertension and is a recognized contributor to adverse cardiovascular (CV) outcomes. While Continuous Positive Airway Pressure (CPAP) remains the primary treatment for OSA, emerging alternatives like pharmacologic agents, oral appliances, and ventilatory support are being explored, especially in patients with resistant hypertension or concomitant CV disease. Methods: A systematic review and meta-analysis were conducted, synthesizing data from 10 studies (out of 223 studies) published in last 15 years, sourced from PubMed, Scopus, and Web of Science Eligible studies included adults with coexisting OSA and hypertension who received interventions such as CPAP, surgery, pharmacologic therapy, or behavioral modification. Outcomes assessed included changes in blood pressure (BP), major adverse cardiovascular events (MACE), stroke, heart failure (HF) hospitalization, and cardiovascular biomarkers. Results: Ten studies involving 870 participants met inclusion criteria. CPAP therapy consistently achieved modest reductions in systolic BP (−4.4 to −10 mmHg) and diastolic BP (up to −7 mmHg). The HIPARCO trial demonstrated a −3.1 mmHg decrease in 24-hour mean BP (p = 0.02), while the MORPHEOS trial reported a −10 mmHg office systolic BP reduction (p < 0.001). Long-term CPAP use maintained systolic BP reductions (−8 mmHg; p = 0.01) and improved BP control in resistant hypertension (40.7% vs 20%; p = 0.024). Acetazolamide reduced mean arterial pressure by 7 mmHg (p = 0.015) and significantly improved apnea-hypopnea index (AHI) when combined with CPAP (p = 0.003). Bosentan yielded a non-significant diastolic BP reduction (−3.1 mmHg; p = 0.101). Oral appliances improved AHI but had limited BP effects. Adaptive servo-ventilation (ASV) surpassed CPAP in lowering BNP levels in HF patients (230.4 vs 847.3 pg/mL; p < 0.05).CPAP reduced cerebrovascular events (HR = 3.1; p = 0.041), hypertensive crises (HR = 5.1; p = 0.006), and MACE. Conclusion: CPAP remains effective for BP control and cardiovascular risk reduction in hypertensive patients with OSA. Combination therapies-particularly CPAP with acetazolamide or ASV-may offer enhanced outcomes. Our findings support a tailored, multimodal treatment strategy and highlight the need for further large-scale RCTs evaluating non-CPAP interventions.