Comparison of Atenolol, Amlodipine, Enalapril, Hydrochlorothiazide, and Losartan for Antihypertensive Treatment in Patients with Obstructive Sleep Apnea

Abstract

We compared the effects of atenolol (50 mg), amlodipine (5 mg), enalapril (20 mg), hydrochlorothiazide (25 mg), and losartan (50 mg) given in once-daily oral doses on office and ambulatory blood pressures (BPs) in patients with hypertension and obstructive sleep apnea (OSA). Each of 40 randomized patients was treated in sequence with two of the five agents (balanced incomplete block design). Treatment periods lasted 6 wk and were separated by a 3-wk washout period. Changes in BP from baseline with the study substances were compared through analysis of variance. Office diastolic BP, our primary outcome variable, was most effectively lowered by atenolol, with all four post hoc differences between atenolol and the remaining substances being statistically significant. Reductions in office systolic and daytime ambulatory BP were not significantly different among the five compounds. However, atenolol reduced mean nighttime ambulatory diastolic and systolic BP more effectively than did amlodipine, enalapril, or losartan (but not hydrochlorothiazide). Severity of sleep-disordered breathing and well-being during the day were not significantly influenced by any of the study compounds. Our findings are in accordance with the hypothesis that an overactivity of the sympathetic nervous system is an important mechanism behind the development or maintenance of hypertension in patients with OSA.

Sleep Apnea and Cardiovascular Disease

“…200,201 Hence, decreased intravascular volume and attenuated venous congestion resulting from heart failure treatment could potentially reduce OSA severity. However, there is no systematic evidence that specific drugs used to treat heart failure have any direct influence on the severity of OSA, 169 apart from an increase in AHI reported in the setting of cough and airway inflammation with angiotensin-converting enzyme inhibitors. 170 …”

Modalities of treatment for sleep disordered breathing

“…Studies also suggest an increase in the risk of myocardial infarction and stroke in untreated OSAHS (Good et al, 1996;Leung et al, 2001;Leung, 2009), Bblockers have been reported to be the most effective among antihypertensive agents, in lowering daytime BP in hypertensive OSA patients as sympathetic overactivity is involved. However antihypertensive medications have little effect on nocturnal BP in OSA, possibly because they do not reduce OSA (Kraiczi et al, 2000). Stress hormones may be triggered by frequent decrease in blood oxygen levels (Crummy et al, 2008) and can increase heart rate and worsen the heart failure.…”

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

“…Another report showed significant reduction of the nocturnal systolic and diastolic BP levels following treatment with b blockers compared with Ca antagonists, ACE inhibitors and angiotensin receptor blockers, although there was no significant difference in the degree of reduction of daytime BP during awakening, nor any difference compared with diuretics. 34 However, one study suggested that nocturnal BP level could only be minimally controlled by single drug administration, including b blockers, although daytime BP levels could be reduced. 35 Thus, no consensus has yet been established on the OSAS-specific efficacy of b-blockers.…”