Antihypertensive therapy for patients with obstructive sleep apnea

作者：Ziegler Michael G^*; Milic Milos; Sun Ping

来源：Current Opinion in Nephrology and Hypertension, 2011, 20(1): 50-55.

DOI：10.1097/MNH.0b013e3283402eb5

• angiotensin-converting enzyme
• atrial natriuretic peptide
• beta adrenergic
• B-type natriuretic peptide
• resistant hypertension

Purpose of review
Patients with obstructive sleep apnea (OSA) often have hypertension that is difficult to control. We review the causes of OSA hypertension and evidence supporting specific therapies.
Recent findings
Sleep apnea commonly accompanies the metabolic syndrome and renal insuffiency. Apneas stimulate atrial natriuretic peptide release and sympathetic nerve activity, which persists throughout the daytime. The combination of increased sympathetic nerve activity and a nocturnal diuresis help explain reports that beta-1 antagonists lower blood pressure more than thiazide diuretics in OSA. The angiotensin-converting enzyme (ACE) inhibitors and angiotensin II blocking drugs have been equally effective in some studies. Patients with treatment-resistant hypertension usually have OSA and have had a good antihypertensive response to spironolactone.
Summary
Although most elderly hypertensives respond to diuretics and calcium channel blockers, patients with OSA responded to beta-1 adrenergic blockers, ACE inhibitors, and angiotensin II blocking drugs. The response to a second drug is not known. However, many patients with OSA remain hypertensive on three antihypertensive agents, in which case the addition of spironolactone has been effective. It is reasonable to prescribe shorter acting antihypertensive drugs at night to treat nocturnal hypertension.

• 出版日期2011-1