Document Detail

Antihypertensive therapy for patients with obstructive sleep apnea.
MedLine Citation:
PMID:  21326007     Owner:  NLM     Status:  MEDLINE    
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 insufficiency. 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 β-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 β-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.
Michael G Ziegler; Milos Milic; Ping Sun
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  20     ISSN:  1473-6543     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-02-17     Completed Date:  2011-06-08     Revised Date:  2013-05-02    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  50-5     Citation Subset:  IM    
University of California San Diego, San Diego, California 92103-8341, USA.
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MeSH Terms
Aldosterone / physiology
Antihypertensive Agents / therapeutic use*
Continuous Positive Airway Pressure
Hypertension / drug therapy*,  epidemiology,  etiology
Renin-Angiotensin System / physiology
Sleep Apnea, Obstructive / diagnosis,  physiopathology*
Sodium / metabolism
Sympatholytics / therapeutic use
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents; 0/Sympatholytics; 52-39-1/Aldosterone; 7440-23-5/Sodium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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