Blood Pressure Response to Losartan and Continuous Positive Airway Pressure in Hypertension and Obstructive Sleep Apnea

Abstract

Losartan reduced BP in OSA, but the reductions were less than in no-OSA. Add-on CPAP therapy resulted in no significant changes in 24-hour BP measures except in patients using CPAP efficiently. Clinical trial registered with www.clinicaltrials.gov (NCT00701428).​

Chronotherapy for hypertension in obstructive sleep apnoea (CHOSA): a randomised, double-blind, placebo-controlled crossover trial

“…Even with this modest effect, epidemiological studies have shown that a similar (4 mm Hg) reduction in night-time BP is associated with a 10% reduction in stroke and 22% reduction in coronary heart disease among subjects aged <60 years 33. This additive effect of CPAP in improving BP has been demonstrated in other studies,10 12 34 35 although they have not all shown improvements in sleep SBP—the most important prognostic marker of cardiovascular disease 17…”

“…Meta-analyses indicate that CPAP, the gold standard treatment for OSA, results in only a modest 1–2 mm Hg reduction in blood pressure (BP),7 8 in part due to poor long-term adherence with this therapy 9. On the other hand, pharmacotherapy with antihypertensive medication results in much larger BP reductions in patients with sleep apnoea,10 11 but not as pronounced as in hypertensive patients without OSA 12. Despite this, in patients with treatment-resistant hypertension, where the use of multiple antihypertensives has failed, the prevalence of unrecognised sleep apnoea is very high, with reports of up to 83% 13.…”

Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial

“…The 24 h BP measurements are more sensitive to therapeutic interventions and provide specific prognostic information. This is particularly true in sleep apnoea-related hypertension 18 43 44. While negative in terms of the primary outcome, our study provides interesting insights regarding 24 h ABPM that might be of clinical relevance and a strong rationale for further studies.…”

Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep

“…Such studies are contributing to our understanding of the pathways by which OSA leads to hypertension and help in choosing the most appropriate antihypertensive agents for patients with OSA. 114 The consequences of not identifying OSA in resistant hypertensive patients are significant. In a retrospective cohort study of over 450 000 hypertensive patients, Bhandari et al 115 reported an increased risk of adverse cardiovascular events in those subjects with sleep apnoea and resistant hypertension compared with those with sleep apnoea and non-resistant hypertension, specifically ischaemic cardiac events and congestive heart failure.…”