Managing hypertension in obstructive sleep apnea: the interplay of continuous positive airway pressure, medication and chronotherapy.
Hypertension is highly prevalent and usually uncontrolled among patients with obstructive sleep apnea despite multiple interventions, namely lifestyle modifications, use of antihypertensive drugs and continuous positive airway pressure application. Main prognosticators of the blood pressure (BP) reduction with continuous positive airway pressure therapy are high levels of BP, severity of apnea and daytime sleepiness. The long-term effect of continuous positive airway pressure on BP is still inconclusive, and compliance issues constitute a major limitation. There is no clear evidence for preference for a specific type of antihypertensive drug, and selection should primarily be guided by the patient's cardiometabolic profile and associated clinical conditions. Furthermore, as hypertensive patients with obstructive sleep apnea frequently exhibit a disturbed circadian BP pattern, chronotherapy emerges as a possible therapeutic supplement.
Tsioufis
Costas
C
First Cardiology Clinic, University of Athens, Hippokration Hospital, Greece. ktsioufis@hippocratio.gr
Kasiakogias
Alexandros
A
Thomopoulos
Costas
C
Manolis
Athanasios
A
Stefanadis
Christodoulos
C
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D045422:Continuous Positive Airway Pressure; D055870:Drug Chronotherapy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
D000959:Antihypertensive Agents