title: Blood Pressure Response to Losartan and Continuous Positive Airway Pressure in Hypertension and Obstructive Sleep Apnea.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is common in people with hypertension, particularly resistant hypertension. Treatment with an antihypertensive agent alone is often insufficient to control hypertension in patients with OSA.
  
  
  OBJECTIVE
  To determine whether continuous positive airway pressure (CPAP) added to treatment with an antihypertensive agent has an impact on blood pressure (BP) levels.
  
  
  METHODS
  During the initial 6-week, two-center, open, prospective, case-control, parallel-design study (2:1; OSA/no-OSA), all patients began treatment with an angiotensin II receptor antagonist, losartan, 50 mg daily. In the second 6-week, sex-stratified, open, randomized, parallel-design study of the OSA group, all subjects continued to receive losartan and were randomly assigned to either nightly CPAP as add-on therapy or no CPAP.
  
  
  RESULTS
  Twenty-four-hour BP monitoring included assessment every 15 minutes during daytime hours and every 20 minutes during the night. Ninety-one patients with untreated hypertension underwent a home sleep study (55 were found to have OSA; 36 were not). Losartan significantly reduced systolic, diastolic, and mean arterial BP in both groups (without OSA: 12.6, 7.2, and 9.0 mm Hg; with OSA: 9.8, 5.7, and 6.1 mm Hg). Add-on CPAP treatment had no significant changes in 24-hour BP values but did reduce nighttime systolic BP by 4.7 mm Hg. All 24-hour BP values were reduced significantly in the 13 patients with OSA who used CPAP at least 4 hours per night.
  
  
  CONCLUSIONS
  Losartan reduced BP in OSA, but the reductions were less than in no-OSA. Add-on CPAP therapy resulted in no significant changes in 24-hour BP measures except in patients using CPAP efficiently. Clinical trial registered with www.clinicaltrials.gov (NCT00701428).​
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and.
authors.forename: Erik
authors.identifier: http://orcid.org/0000-0002-9134-2107
authors.initials: E
authors.lastname: Thunström
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and.
authors.forename: Karin
authors.initials: K
authors.lastname: Manhem
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and.
authors.forename: Annika
authors.identifier: http://orcid.org/0000-0002-5409-6605
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: 1 Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and.|2 Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Yüksel
authors.identifier: http://orcid.org/0000-0001-9067-6538
authors.initials: Y
authors.lastname: Peker
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects*; D016022:Case-Control Studies; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D019808:Losartan / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy
chemical_list: D057911:Angiotensin Receptor Antagonists; D019808:Losartan
keywords: continuous positive airway pressure; hypertension; losartan; obstructive sleep apnea; randomized controlled trial