CPAP novel non pharmacologic option for managing supine hypertension in Autonomic failure

A new study found that continuous positive airway pressure (CPAP) can be used as a novel nonpharmacologic approach for the management of supine hypertension of autonomic failure while improving nocturia and daytime orthostatic hypotension (OH).

The trial results were published in the journal Hypertension. 

Many of the patients with orthostatic hypotension are affected by supine hypertension due to autonomic failure.  It is often not managed for fear of worsening OH. Hence Luis E. Okamoto et al conducted a trial based on a hypothesis that increasing intrathoracic pressure with continuous positive airway pressure (CPAP) can be used to manage nocturnal supine hypertension while reducing nocturnal pressure diuresis and improving daytime OH. This is due to the Valsalva-like blood-pressure-lowering effect. 

Two protocols were made where in Protocol 1, the acute hemodynamic effects of increasing levels of CPAP (0, 4, 8, 12, and 16 cm H2O, 3 minutes each) were determined in 26 patients with autonomic failure and supine hypertension were studied while awake and supine. In Protocol 2 (n=11), the effects of overnight therapy with CPAP (8–12 cm H2O for 8 hours) were compared versus placebo on nocturnal supine hypertension, nocturnal diuresis, and daytime OH in a 2-night crossover study. 

Key findings of the study:

• In Protocol 1, systolic blood pressure was reduced by the acute CPAP (4–16 cm H2O) in a dose-dependent manner due to reductions in stroke volume and cardiac output. 
• There was no change in the systemic vascular resistance and heart rate. 
• In Protocol 2, nighttime systolic blood pressure was reduced by overnight CPAP and was associated with lower nighttime diuresis and improved morning orthostatic tolerance. 

Thus, CPAP was found to be a novel nonpharmacologic approach to managing supine hypertension of autonomic failure while improving nocturia and daytime OH.

Further treatment: Okamoto LE, Celedonio JE, Smith EC, et al. Continuous Positive Airway Pressure for the Treatment of Supine Hypertension and Orthostatic Hypotension in Autonomic Failure [published online ahead of print, 2023 Jan 5]. Hypertension. 2023;10.1161/HYPERTENSIONAHA.122.20081. doi:10.1161/HYPERTENSIONAHA.122.20081