Table 3.
Studies of the efficacy of AHDs in OSA patients.
| Study design | n | CPAP (Y/N) | AHDs; dosage (mg/day) | BP measurement | BP outcome | References |
|---|---|---|---|---|---|---|
| RCT; double-blinded; balanced incomplete block design (6 w each drug + 3 w washout) | 40 | No | Atenolol (50); amlodipine (5); enalapril (20); hydrochlorothiazide (25); losartan (50) | Office BP 24 h ABPM | ↓ in office SBP and daytime ABPM NS for all drugs; Atenolol ↓ night-time 24 h SBP and DBP more effectively than amlodipine, enalapril or losartan | Kraiczi et al., 2000 |
| RCT; double-blinded; crossover schedule (8 w each drug + 2–3 w washout | 15 | No | Atenolol (50); isradipine (2.5): hydrochlorothiazide (25); spirapril (6) | Office BP | Slight ↓ BP for all drugs; Only atenolol affected BP variability | Salo et al., 1999 |
| RCT; double-blinded; crossover (8 w each drug + 2–3 w washout | 18 | NA | Atenolol (50); isradipine (2.5); hydrochlorothiazide (25); spirapril (6) | 24 h ABPM | ↓ mean 24 h SBP (except for HCTZ) ↓ mean 24 h DBP (for all drugs) NS ↓ mean night-time SBP and DBP (for all drugs) | Pelttari et al., 1998 |
| RCT (3 months each treatment) | 75 | Yes | Treatment with at least 3 drugs at adequate doses, including a diuretic | 24 h ABPM | CPAP + AHDs regimen: ↓ 4.9 mmHg 24 h DBP; AHDs regimen alone: NS | Lozano et al., 2010 |
| RCT; single-blinded (3 w each regimen) | 44 | Yes | Valsartan (160) + amlodipine (5–10) + hydrochlorothiazide (25) | Office BP 24 h ABPM | AHDs alone: ↓ office and 24 h SBP and DBP Additional ↓ in office BP and ambulatory BP monitoring (CPAP+ 3 AHDs) | Litvin et al., 2013 |
| RCT; crossover (8 w each treatment + 4 w washout) | 23 | Yes | Valsartan (160) | Office BP 24 h ABPM | CPAP: ↓ 2.1 mmHg 24 h MBP and ↓ 1.3 mmHg night-time MBP (NS) VAL: ↓ 9.1 mmHg 24 h MBP and ↓ 6.1 mmHg night-time MBP | Pépin et al., 2009 |
| RCT (8 w) | 12 | No | Spironolactone (25–50) added to current medication (mean number of AHDs: 4.3 (SD = 1.1) | Office BP 24 h ABPM | ↓ 17 mmHg 24 h SBP ↓ 10 mmHg 24 h DBP | Gaddam et al., 2010 |
| RCT; double-blinded (8 days) | 12 | NA | Metoprolol (100); cilazapril (2.5) | Office BP 24 h ABPM | MET: ↓ 13 mmHg 24 h SBP and ↓ 5 mmHg 24 h DBP CIL: ↓ 13 mmHg 24 h SBP and ↓ 17 mmHg 24 h DBP | Mayer et al., 1990 |
| RCT; double-blinded; crossover (2 w each treatment + 3 w washout) | 16 | No | Doxazosin (4–8); enalapril (10–20) | 24 h ABPM | DOX: ↓ 4.1 mmHg 24 h SBP and ↓ 5.1 mmHg 24 h DBP EN: ↓ 12.6 mmHg 24 h SBP and ↓ 8.9 mmHg 24 h DBP 24 h MBP: no differences between groups | Zou et al., 2010 |
| RCT; double-blinded; parallel group; single center (6 w) | 31 | No | Nebivolol (5); valsartan (80) | Office BP | NEB: ↓ 14.6 mmHg SBP and ↓ 8.6 mmHg DBP VAL: ↓ 11.6 mmHg SBP and ↓ 8.9 mmHg DBP No differences between treatments | Heitmann et al., 2010 |
| RCT; prospective; crossover; parallel group (2 single doses of each drug + 2 w washout) | 11 | No | Nifedipine slow-release (40); carvedilol (20) | Office BP TSP method | NIF: ↓ 24.2 mmHg mean SBP and ↓ 18.7 mmHg mean DBP CAR: ↓ 16 mmHg mean SBP and ↓ mean 8.6 mmHg DBP | Kario et al., 2014 |
| RCT; double-blinded; placebo-controlled (8 days) | 23 | NA | Cilazapril (2.5) | Invasive arterial BP (arteria brachialis) | ↓ 10 mmHg MBP (vs. ↓ 4.3 mmHg MBP for placebo) | Grote et al., 1994 |
ABPM, ambulatory blood pressure monitoring; AHDs, antihypertensive drugs; BP, blood pressure; CAR, carvedilol; CIL, cilazapril; CPAP, continuous positive airway pressure; DBP, diastolic blood pressure; DOX, doxazosin; EN, enalapril; HCTZ, hydrochlorothiazide; MBP, mean blood pressure; MET, metoprolol; NA, information not available; NEB, nebivolol; NIF, nifedipine; NS, no significant effect; RCT, randomized controlled trials; SBP, systolic blood pressure; SD, standard deviation; TSP, trigger sleep BP monitoring; VAL, valsartan; w, week; ↓, decrease.