title: Antihypertensive therapy for patients with obstructive sleep apnea.
abstract: OBJECTIVE
  Patients with obstructive sleep apnea (OSA) often have hypertension that is difficult to control. We review the causes of OSA hypertension and evidence supporting specific therapies.
  
  
  RESULTS
  Sleep apnea commonly accompanies the metabolic syndrome and renal insufficiency. Apneas stimulate atrial natriuretic peptide release and sympathetic nerve activity, which persists throughout the daytime. The combination of increased sympathetic nerve activity and a nocturnal diuresis help explain reports that β-1 antagonists lower blood pressure more than thiazide diuretics in OSA. The angiotensin-converting enzyme (ACE) inhibitors and angiotensin II blocking drugs have been equally effective in some studies. Patients with treatment-resistant hypertension usually have OSA and have had a good antihypertensive response to spironolactone.
  
  
  CONCLUSIONS
  Although most elderly hypertensives respond to diuretics and calcium channel blockers, patients with OSA responded to β-1 adrenergic blockers, ACE inhibitors, and angiotensin II blocking drugs. The response to a second drug is not known. However, many patients with OSA remain hypertensive on three antihypertensive agents, in which case the addition of spironolactone has been effective. It is reasonable to prescribe shorter acting antihypertensive drugs at night to treat nocturnal hypertension.
authors.affiliation: University of California San Diego, San Diego, California 92103-8341, USA. mziegler@ucsd.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ziegler
authors.forename: Milos
authors.initials: M
authors.lastname: Milic
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
mesh_terms: D000450:Aldosterone / Q000502:physiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D045422:Continuous Positive Airway Pressure; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D012084:Renin-Angiotensin System / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology*; D012964:Sodium / Q000378:metabolism; D013565:Sympatholytics / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D013565:Sympatholytics; D000450:Aldosterone; D012964:Sodium