NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), and NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Thorax. 2017 Jun;72(6):550-558. doi: 10.1136/thoraxjnl-2016-209504. Epub 2016 Dec 14.
Obstructive sleep apnoea (OSA) is an important cause of secondary hypertension. Nocturnal hypertension is particularly prevalent in OSA and is a strong predictor of cardiovascular mortality. Studies in patients with essential hypertension have suggested that nocturnal administration of antihypertensives improves nocturnal blood pressure (BP) without elevating daytime BP. We evaluated the efficacy of this technique in patients with OSA with stage I/II hypertension, both before and after the addition of CPAP.
In this double-blind randomised placebo-controlled crossover trial, patients with moderate-to-severe OSA and hypertension received 6 weeks each of evening or morning perindopril with opposing time-matched placebo. CPAP therapy was subsequently added for 8 weeks in addition to either morning or evening perindopril. The primary outcome was sleep systolic BP (SBP) using 24-hour BP monitoring, analysed using linear mixed models.
Between March 2011 and January 2015, 85 patients were randomised, 79 completed both dosing times, 78 completed the CPAP phase. Sleep SBP reduced significantly from baseline with both evening (-6.9 mm Hg) and morning (-8.0 mm Hg) dosing, but there was no difference between dosing times (difference: 1.1 mm Hg, 95% CI -0.3 to 2.5). However, wake SBP reduced more with morning (-9.8 mm Hg) than evening (-8.0 mm Hg) dosing (difference: 1.8 mm Hg, 95% CI 1.1 to 2.5). Addition of CPAP to either evening or morning dosing further reduced sleep SBP, but by a similar amount (evening: -3.2 mm Hg, 95% CI -5.1 to -1.3; morning: -3.3 mm Hg, 95% CI -5.2 to 1.5).
Our findings support combining OSA treatment with morning administration of antihypertensives. Unlike in essential hypertension, our results do not support evening administration of antihypertensives, at least with perindopril. Further research is required before this strategy can be widely adopted into hypertension guidelines and clinical practice.
ACTRN12611000216910, Results.
阻塞性睡眠呼吸暂停（OSA）是继发性高血压的重要原因。夜间高血压在 OSA 中尤为普遍，是心血管死亡率的强有力预测因子。在原发性高血压患者中的研究表明，夜间给予降压药可以改善夜间血压（BP）而不升高白天血压。我们评估了这种技术在 I/II 期高血压合并 OSA 患者中的疗效，包括在添加 CPAP 前后。
在这项双盲随机安慰剂对照交叉试验中，患有中重度 OSA 和高血压的患者接受了 6 周的培哚普利，晚上或早上服用，同时给予相反时间匹配的安慰剂。随后在 8 周内添加 CPAP 治疗，同时给予早上或晚上的培哚普利。主要结局是使用 24 小时血压监测评估睡眠收缩压（SBP），采用线性混合模型进行分析。
2011 年 3 月至 2015 年 1 月期间，共 85 名患者被随机分组，79 名患者完成了两次剂量的治疗，78 名患者完成了 CPAP 阶段的治疗。与基线相比，晚上（-6.9mmHg）和早上（-8.0mmHg）服药均可显著降低睡眠 SBP，但两种服药时间之间无差异（差异：1.1mmHg，95%CI -0.3 至 2.5）。然而，与晚上（-8.0mmHg）相比，早上（-9.8mmHg）服药可使清醒 SBP 显著降低（差异：1.8mmHg，95%CI 1.1 至 2.5）。CPAP 分别添加到晚上或早上的给药中，可进一步降低睡眠 SBP，但降低幅度相似（晚上：-3.2mmHg，95%CI -5.1 至 -1.3；早上：-3.3mmHg，95%CI -5.2 至 1.5）。
我们的研究结果支持将 OSA 治疗与清晨给予降压药相结合。与原发性高血压不同，我们的结果不支持晚上给予降压药，至少在使用培哚普利时是这样。在这种策略能够广泛纳入高血压指南和临床实践之前，还需要进一步研究。
ACTRN12611000216910，结果。
