Ou Yi-Hui, Tan Adeline, Lee Chi-Hang
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Respiratory Medicine, Ng Teng Fong General Hospital, Singapore.
Am J Prev Cardiol. 2023 Feb 15;13:100475. doi: 10.1016/j.ajpc.2023.100475. eCollection 2023 Mar.
Obstructive sleep apnea (OSA) plays an important role in the development of hypertension. Thus, this review summarizes pharmacological and non-pharmacological approaches to blood pressure (BP) control in patients with OSA. Current treatments for OSA, such as continuous positive airway pressure, are effective at lowering BP. However, they only provide a modest BP reduction, and pharmacological treatment remains important for achieving optimal BP control. Furthermore, current guidelines for the treatment of hypertension do not make specific recommendations on pharmacological treatment protocols for controlling BP in patients with OSA. Moreover, the BP-lowering effects of various classes of antihypertensives may be different in hypertensive patients with OSA than in those without OSA due to the underlying mechanisms that promote hypertension in OSA. The acute and chronic increase in sympathetic nerve activity in patients with OSA explain the effectiveness of beta blockers in controlling BP in these patients. As activation of the renin-angiotensin-aldosterone system may also promote hypertension in OSA, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have generally been found effective for lowering BP in hypertensive patients with OSA. The aldosterone antagonist spironolactone also produces a good antihypertensive response in patients with OSA and resistant hypertension. However, there are limited data available that compare the effects of various classes of antihypertensive medication on BP control in those with OSA, and most data have been obtained from small-scale studies. This demonstrates the need for large-scale randomized controlled trials to evaluate a range of BP-lowering regimens in patients with OSA and hypertension.
阻塞性睡眠呼吸暂停（OSA）在高血压的发生发展中起重要作用。因此，本综述总结了阻塞性睡眠呼吸暂停患者控制血压的药物和非药物方法。目前治疗阻塞性睡眠呼吸暂停的方法，如持续气道正压通气，在降低血压方面是有效的。然而，它们只能使血压适度降低，药物治疗对于实现最佳血压控制仍然很重要。此外，目前的高血压治疗指南并未针对阻塞性睡眠呼吸暂停患者控制血压的药物治疗方案给出具体建议。而且，由于阻塞性睡眠呼吸暂停中促进高血压的潜在机制，各类抗高血压药物对阻塞性睡眠呼吸暂停高血压患者的降压效果可能与非阻塞性睡眠呼吸暂停患者不同。阻塞性睡眠呼吸暂停患者交感神经活动的急性和慢性增加解释了β受体阻滞剂对这些患者控制血压的有效性。由于肾素-血管紧张素-醛固酮系统的激活也可能在阻塞性睡眠呼吸暂停中促进高血压，一般发现血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂对阻塞性睡眠呼吸暂停高血压患者降低血压有效。醛固酮拮抗剂螺内酯对阻塞性睡眠呼吸暂停和顽固性高血压患者也有良好的降压反应。然而，比较各类抗高血压药物对阻塞性睡眠呼吸暂停患者血压控制效果的数据有限，且大多数数据来自小规模研究。这表明需要进行大规模随机对照试验，以评估阻塞性睡眠呼吸暂停和高血压患者的一系列降压方案。
