title: Comparison of continuous positive airway pressure and bosentan effect in mildly hypertensive patients with obstructive sleep apnoea: A randomized controlled pilot study.
abstract: OBJECTIVE
  Randomized controlled trials (RCT) have shown that continuous positive airway pressure (CPAP) has only limited impact on blood pressure (BP). Alternative strategies for obstructive sleep apnoea (OSA)-associated hypertension are therefore needed. Endothelin-1 has been demonstrated a key player in the deleterious cardiovascular consequences of OSA. In OSA, CPAP treatment has never been compared with endothelin receptor antagonist medications. Thus, we assessed the respective efficacy of CPAP and bosentan in reducing 24-h diastolic BP (DBP) in patients with OSA never treated by either therapy.
  
  
  METHODS
  In a crossover pilot study, 16 mildly hypertensive patients (office systolic BP (SBP)/DBP: 142 ± 7/85 ± 8 mm Hg) with severe OSA (55 ± 8 years; body mass index, 29.6 ± 4.2 kg/m(2) ; apnoea-hypopnoea index, 40.8 ± 20.2/h) were randomized to either CPAP (n = 7) or bosentan (125 mg/day, n = 9) first for 4 weeks. After 2-weeks of washout, the second 4-week period consisted of the alternative treatment (in crossover). The primary outcome was the 24-h mean DBP change after treatment.
  
  
  RESULTS
  In intention-to-treat analysis, the mean difference in 24-h DBP measurements between treatments was -3.1 (-6.9/0.7) mm Hg (median, 25th/75th percentiles) (P = 0.101) with bosentan having a greater effect.
  
  
  CONCLUSIONS
  In this RCT, in mildly hypertensive patients with OSA, bosentan did not modify 24-h DBP but only reduced office BP suggesting that Endothelin-1 blockade does not play a major role in treatment of OSA-related hypertension.
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Joyeux-Faure
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Jullian-Desayes
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pepin
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Clinical Investigation Centre, Grenoble University Hospital, Grenoble, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Cracowski
authors.affiliation: Cardiology Department, Grenoble University Hospital, Grenoble, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Baguet
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Tamisier
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Levy
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Godin-Ribuot
authors.affiliation: HP2 Laboratory, Inserm, U1042, Grenoble Alpes University, Grenoble, France.|Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
authors.forename: Sandrine H
authors.initials: SH
authors.lastname: Launois
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D000077300:Bosentan; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D065128:Endothelin Receptor Antagonists / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013449:Sulfonamides / Q000008:administration & dosage*
chemical_list: D065128:Endothelin Receptor Antagonists; D013449:Sulfonamides; D000077300:Bosentan
keywords: continuous positive airway pressure; endothelin receptor antagonist; hypertension; obstructive sleep apnoea