Comparison of Continuous Positive Airway Pressure and Valsartan in Hypertensive Patients with Sleep Apnea

Rationale Randomized controlled trials (RCTs) have shown that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) reduces blood pressure (BP). CPAP treatment has never been compared with antihypertensive medications in an RCT. Objectives: To assess the respective efficacy of (PAP and valsartan in reducing BP in hypertensive patients with OSA never treated for either condition. Methods: In this 8-week randomized controlled crossover trial, 23 hypertensive patients (office systolic BP/diastolic BP: 155 +/- 14/102 +/- 11 mm Hg) with OSA (age, 57 +/- 8 yr; body mass index, 28 +/- 5 kg/m(2); apnea hypopnea index, 29 +/- 18/h) were randomized first to either (PAP or valsartan (160 mg). The second 8-week period consisted of the alternative treatment (crossover) after a 4-week washout period. Measurements and Main Results: Office BP and 24-hour BP were measured before and at the end of the two active treatment periods. Twenty-four hour mean BP was the primary outcome variable. There was an overall significant difference in 24-hour mean BP between treatments: the change in 24-hour mean BP was -2.1 +/- 4.9 mm Hg (P < 0.01) with (PAP, and -9.1 +/- 7.2 mm Hg with valsartan (P < 0.001), with a difference of -7.0 mm Hg (95% confidence interval, -10.9 to -3.1 mm Hg; P < 0.001). The difference was significant not only during daytime but also during nighttime: the change in nighttime mean BP with (PAP was -1.3 +/- 4.6 mm Hg (not significant), and -7.4 +/- 8.4 mm Hg with valsartan (P < 0.001), with a difference of -6.1 mm Hg (P < 0.05) (95% confidence interval, -10.8 to -1.4 mm Hg). Conclusions: In an RCT, although the BP decrease was significant with (PAP treatment, valsartan induced a fourfold higher decrease in mean 24-hour BP than (PAP in untreated hypertensive patients with OSA. Clinical trial registered with www.clinicaltrials.gov (NCT00409487).