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

Abstract

ACTRN12611000216910, Results.

Chronotherapy for Hypertension

“…In contrast to the above studies, a RCT in patients with moderate to severe OSA and HTN showed that an ACEI taken at night did not further reduce nocturnal SBP compared with morning dosing (−6.9 mmHg, −8.0 mmHg, respectively); regardless of the addition of CPAP, which similarly lowered sleep SBP both with morning and evening dosing (142). Morning compared to evening administration of the ACEI was also superior at reducing daytime SBP.…”

Do patients with obstructive sleep apnoea deserve new dedicated antihypertensive strategies?

“…In the MAPEC study, chronotherapy improved nocturnal blood pressure and led to a 17% reduction in cardiovascular risk for each 5 mm Hg reduction in systolic blood pressure during sleep (p<0.001) in patients with essential hypertension 15. The negative findings by Serinel et al 12 demonstrate that such results cannot be extrapolated to the OSA population. While CPAP is the gold standard treatment for OSA, it is not necessarily effective in reducing blood pressure, particularly if adherence to treatment is low.…”

“…The study presented in this issue of Thorax by Serinel et al 12 attempted to address one piece of the puzzle regarding a better strategy for managing OSA-related hypertension. Using a well-established cross-over randomised controlled trial design, the authors explored whether chronotherapy would be of particular benefit in hypertensive patients with OSA.…”

“…The study by Serinel et al 12 is a well-conducted and analysed RCT. Some limitations may be the absence of a non-OSA hypertensive group and not using sham-CPAP, although these might have had only a marginal impact on the reported results.…”

The chronotherapy of hypertension: or the benefit of taking blood pressure tablets at bedtime

“…Of note, the intervention, according to the MAPEC authors, appears to be particularly appropriate in diabetics, 6 those with chronic kidney disease (CKD), 7 those with nocturnal hypertension, but not those with obstructive sleep apnoea (OSA). 8 There is clearly scope to repeat a trial similar to MAPEC in a UK general practice population. These trials also raise questions about the use and funding of 24-hour ambulatory BP monitoring not just for diagnosis, but also for monitoring.…”