Kantola IM, Pelttari LH, Hietanen EK, Kataja MJ, Ekman KM
Scant effect of antihypertensive monotherapy on nocturnal
blood pressure in patients with obstructive sleep apnea
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:5A 1996
The role of sleep apnea in hypertension is now well appreciated. In a
another abstract presented at
the ASH meeting by
Somers et al. , the role of the sympathetic nervous system in sleep apnea
is described.
In the present study, the 24 hour BP profile was studied in patients with
hypertension and partial
upper airway obstruction. Isradipine, atenolol, or hydrochlorothiazide all
reduced daytime systolic
BP and mean 24 hour diastolic BP. However, none reduced the mean nighttime
systolic or diastolic
BP. The conclusion is, that perhaps a different dosing schedule or
combination therapy might be
required in patients with obstructive sleep apnea.
Comment: This study is quite flawed, as the number of patients was not
specified, and there
was no control group without sleep apnea. Still, it poses an interesting
question, in the growing
field of chronotherapy. Given that there is sympathetic activation during
sleep apnea, probably due
to periodic loss of respiratory mediated cardiac filling (see Somers et al,
above), one might choose
a sympathoplegic drug for such patients. However, interference with this
normal physiologic
response to apnea might conceivably be harmful. An alternative might be
giving the medications in
the evening, as suggested for non-obstructive patients in the
ASH abstract by Anderson et al.
I suspect that control of nocturnal BP in such patients might better be
directed to control of
their sleep apnea episodes.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
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11th Scientific Meeting, American Society of Hypertension
H: Drug therapy :
Chronotherapeutics
H: Pathophysiology :
Sleep, sleep apnea