Impact of adherence and study design on CPAP effectiveness in resistant hypertension

This letter comments on the recent article by Fernandes et al. evaluating the long-term effects of continuous positive airway pressure (CPAP) in patients with resistant hypertension and obstructive sleep apnea. While the study provides valuable insights into prolonged CPAP use, its non-randomized design and reliance on per-protocol analyses limit the generalizability of the findings. Evidence from previous randomized and multicenter studies suggests that the benefits of CPAP are modest and often diminish over time. Moreover, the exclusive focus on blood pressure outcomes overlooks broader cardiovascular effects, and the role of psychosocial and socioeconomic determinants of adherence remains underexplored. Future large-scale, randomized studies that integrate clinical and behavioral factors are needed to better define the long-term role of CPAP in resistant hypertension management.