Crippa G, Zabzuni D, Cassi A, Bravi E
Department of Internal Medicine, Hypertension Unit, Guglielmo Da Saliceto Hospital, Piacenza, Italy.
Eur Rev Med Pharmacol Sci. 2016;20(2):339-44.
Obstructive sleep apnoea (OSA) is considered a cause of secondary hypertension. About 50% of patients with OSA show elevated blood pressure levels. Non-dipper pattern (blunted or absent nocturnal decrease of blood pressure) is frequently observed in patients with OSA and is associated with increased cerebral, cardiovascular and renal events. The aim of this study was to observe the effect of barnidipine calcium channel blocker on these patients.
Forty-one patients (mean age 69 ± 17 years, 18 females) with previously diagnosed OSA (by reduced channel home-based polysomnography) who were not being treated with continuous positive airway pressure (CPAP) because of contraindications or because of patient intolerance or rejection were evaluated. Non-dipper status was defined as the presence of a nighttime fall in systolic blood pressure (BP) which was < 10% that of daytime systolic BP as observed in a previous ambulatory blood pressure (ABP) monitoring. OSA was defined according to the presence of 5 or more episodes per hour of apnoea, hypopnoea or arousal due to respiratory effort. The reproducibility of non-dipping status was confirmed through a second 24-h ABP monitoring performed at baseline. On top of the previous stable treatment regimen (which excluded calcium-channel blockers), a 10 mg dosing of barnidipine hydrochloride at bedtime was added to all subjects during a 12-week period.
Among the 41 non-dipper patients, 32 (78%) showed complete normalization of circadian rhythm. Add-on treatment with barnidipine was generally well tolerated.
Bedtime dosing of the calcium-channel blocker (CCB) barnidipine significantly reduced mean nighttime systolic and diastolic ABP in hypertensive patients presenting with non-dipper pattern and OSA--not on CPAP treatment. Moreover, it restored the previously altered circadian rhythm in the majority of them.
阻塞性睡眠呼吸暂停（OSA）被认为是继发性高血压的一个病因。约50%的OSA患者血压水平升高。非勺型血压模式（夜间血压下降减弱或消失）在OSA患者中经常出现，并且与脑、心血管和肾脏事件增加有关。本研究的目的是观察巴尼地平钙通道阻滞剂对这些患者的影响。
对41例先前已确诊OSA（通过基于家庭的简化通道多导睡眠图）的患者进行评估，这些患者因禁忌症、患者不耐受或拒绝而未接受持续气道正压通气（CPAP）治疗。非勺型状态定义为夜间收缩压（BP）下降幅度小于先前动态血压（ABP）监测中白天收缩压的10%。OSA根据每小时出现5次或更多次呼吸暂停、呼吸浅慢或因呼吸努力引起的觉醒情况来定义。通过在基线时进行的第二次24小时ABP监测确认非勺型状态的可重复性。在先前稳定的治疗方案（不包括钙通道阻滞剂）基础上，在12周期间给所有受试者在睡前加用10 mg盐酸巴尼地平。
在41例非勺型患者中，32例（78%）昼夜节律完全恢复正常。加用巴尼地平治疗一般耐受性良好。
对于呈现非勺型血压模式且未接受CPAP治疗的OSA高血压患者，睡前服用钙通道阻滞剂（CCB）巴尼地平可显著降低夜间平均收缩压和舒张压。此外，它使大多数患者先前改变的昼夜节律得以恢复。
