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Do patients with obstructive sleep apnoea deserve new dedicated antihypertensive strategies?
  1. Renaud Tamisier1,2,
  2. Patrick Lévy1,2,
  3. Jean-Louis Pépin1,2
  1. 1HP2 Laboratory, Inserm, Univ. Grenoble Alpes, Grenoble, France
  2. 2Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
  1. Correspondence to Dr Renaud Tamisier, Laboratoire EFCR, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; rtamisier{at}chu-grenoble.fr

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Hypertension affects 25% of the adult population and remains a leading cause of cardiovascular mortality, accounting for 13.5% of all deaths. Half of all strokes and ischaemic heart disease events are attributed to hypertension.1 ,2 Most patients exhibit grade I hypertension (systolic blood pressure of 140–159 mm Hg and/or diastolic blood pressure of 90–99 mm Hg) without coexisting cardiovascular disease. Effective reduction of blood pressure in this population significantly reduces stroke and death.3

Obstructive sleep apnoea (OSA) is now recognised as a risk factor for the development of hypertension in European and the US International Guidelines. In OSA, elevation of blood pressure is in part due to intermittent hypoxaemia leading to increased sympathetic tone and impaired baroreflex gain.4 Altered arterial vasoconstriction and vasodilatation5 owing to stimulation of the renin-angiotensin-aldosterone system (RAAS)6 are also significant contributors. Although OSA and hypertension are tightly linked in a dose-response manner, the impact of short-term OSA treatment on blood pressure reduction in unselected patient populations with OSA is rather mild, about 2 mm Hg reduction in 24-hour mean blood pressure. This effect is slightly greater in patients who are compliant with CPAP or mandibular advancement devices, presumably by allowing rapid eye movement (REM) sleep at the end of the night to be free of obstructive respiratory events.7–9

It stands to reason that treatment strategies combining OSA treatment and pharmacological antihypertensives would be synergistic.10 ,11 Previous studies10 ,11 have demonstrated that in hypertensive patients with OSA, losartan or valsartan are by far more effective than CPAP in reducing blood pressure, even if nocturnal blood pressure is better controlled when CPAP is used concurrently with these medications. This underlines the need for specific strategies to be further studied in …

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