According to a press release from the American College of Cardiology (ACC), mandibular advancement devices may be noninferior to continuous positive airway pressure (CPAP) devices in reducing blood pressure in patients with hypertension and obstructive sleep apnea. Obstructive sleep apnea can often cause or worsen hypertension and may be managed with CPAP devices; however, patients do not always adhere to their sustained use because of low tolerability. Mandibular advancement devices work by repositioning the lower jaw and tongue to keep the airway open and have been shown to be more comfortable than CPAPs in prior research. In a study presented by Chi-Hang et al at the ACC Annual Scientific Session 2024 and simultaneously published by Ou et al in the Journal of the American College of Cardiology, researchers randomly assigned 220 patients with uncontrolled hypertension and moderate-to-severe obstructive sleep apnea to use either a mandibular advancement device or CPAP device. After a follow-up of 6 months, reductions in the 24-hour ambulatory mean blood pressure were 1.64 mmHg greater among the patients in the mandibular advancement device group compared with those in the CPAP device group. Further, the patients who used mandibular advancement devices experienced larger between-group reductions in all ambulatory blood pressure measures—including nighttime blood pressure—and were more likely to achieve systolic blood pressure below 120 mmHg compared with those who used CPAP devices. The researchers reported that 56.5% of the patients assigned to the mandibular advancement device group and 23.2% of those assigned to the CPAP device group exhibited adherence to the use of the devices for 6 hours per night until the end of the study period—potentially elucidating the results of the nighttime blood pressure measure. The researchers hope their findings can inspire the more widespread use of mandibular advancement and CPAP devices in this patient population. They emphasized that CPAP devices should still be considered first-line therapy until further studies are conducted to understand the benefits of mandibular advancement devices more fully. “[F]or patients who truly cannot tolerate or accept using a CPAP [device], we should be more open-minded in looking for an alternative therapy such as a [mandibular advancement device], which … numerically had a better blood pressure reduction in patients compared with a CPAP [device],” concluded lead study author Ronald Lee Chi-Hang, MD, Professor of Medicine at the Yong Loo Lin School of Medicine at the National University of Singapore and a senior consultant in the Department of Cardiology at the National University Heart Centre in Singapore.