Impact of Sleep Apnea Treatment With Continuous Positive Airway Pressure (CPAP) on Blood Pressure Control in Resistant Hypertension: A Systematic Review and Meta-Analysis

High-risk cardiovascular factors such as resistant hypertension (RH) are often correlated with obstructive sleep apnoea (OSA), which can further contribute to the elevation of blood pressure (BP) and cardiovascular morbidity. The use of continuous positive airway pressure (CPAP) therapy has been suggested to be an effective intervention to enhance the management of BP in patients with RH and OSA. The purpose of this systematic review and meta-analysis was to determine the impact of CPAP treatment on the decrease in BP and associated heart parameters in this risk group. Randomised controlled trials (RCTs), prospective intervention studies, and observational studies published between 2010 and 2025 were searched in PubMed, Cochrane Library, and Google Scholar using a comprehensive literature search. A random-effects model was performed: the pooled effect sizes showed that CPAP therapy had a significantly lower BP than the control (r = 0.96, 95% CI: 0.64-1.28), which is a moderate effect size. Subgroup analysis indicated that the longer the period and the higher the BP reductions were, the greater the adherence. There was high heterogeneity (I² = 92.72%), which was associated with variations in study populations, CPAP compliance, and intervention protocols. None of the publication bias was significant. Finally, CPAP treatment is a beneficial adjunctive treatment to enhance BP control in RH and OSA patients and has other cardiovascular advantages. Adherence to therapies is more beneficial in the long term, which explains the need to tailor treatment plans to individual needs. Long-term cardiovascular outcomes, the optimisation of adherence, and predictors of response to CPAP therapy in this population should be addressed in future research.