期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 193, 期 3, 页码 310-320出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.201505-0998OC
关键词
hypertension; obstructive sleep apnea; losartan; continuous positive airway pressure; randomized controlled trial
资金
- Vastra Gotalandsregionen grants [ALFGBG-11538, ALFGBG-150801]
- Research Fund at Skaraborg Hospital grants [VGSKAS-10375, VGSKAS-12916, VGSKAS-40311]
- Skaraborg Research and Development Council [VGFOUSKB-46381]
- Health and Medical Care Committee of the Regional Executive Board, Region Vastra Gotaland grant [VGFOUREG-159211]
- Gothenburg Medical Society
- Sleep Medicine Society
- Cardiovascular Research Foundation
- Sahlgrenska Ostra Hospital
- ResMed Sweden
- Swedish Sleep Research
Rationale: Obstructive sleep apnea (OSA) is common in people with hypertension, particularly resistant hypertension. Treatment with an antihypertensive agent alone is often insufficient to control hypertension in patients with OSA. Objectives: To determine whether continuous positive airway pressure (CPAP) added to treatment with an antihypertensive agent has an impact on blood pressure (BP) levels. Methods: During the initial 6-week, two-center, open, prospective, case-control, parallel-design study (2:1; OSA/no-OSA), all patients began treatment with an angiotensin II receptor antagonist, losartan, 50 mg daily. In the second 6-week, sex-stratified, open, randomized, parallel-design study of the OSA group, all subjects continued to receive losartan and were randomly assigned to either nightly CPAP as add-on therapy or no CPAP. Measurements and Main Results: Twenty-four hour BP monitoring included assessment every 15 minutes during daytime hours and every 20 minutes during the night. Ninety-one patients with untreated hypertension underwent a home sleep study (55 were found to have OSA; 36 were not). Losartan significantly reduced systolic, diastolic, and mean arterial BP in both groups (without OSA: 12.6, 7.2, and 9.0 mm Hg; with OSA: 9.8, 5.7, and 6.1 mm Hg). Add-on CPAP treatment had no significant changes in 24-hour BP values but did reduce nighttime systolic BP by 4.7 mm Hg. All 24-hour BP values were reduced significantly in the 13 patients with OSA who used CPAP at least 4 hours per night. Conclusions: 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.
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