title: Effect of bedtime dosing of barnidipine hydrochloride in non-dipper hypertensive patients with obstructive sleep apnoea not treated with continuous positive airway pressure.
abstract: OBJECTIVE
  Obstructive sleep apnoea (OSA) is considered a cause of secondary hypertension. About 50% of patients with OSA show elevated blood pressure levels. Non-dipper pattern (blunted or absent nocturnal decrease of blood pressure) is frequently observed in patients with OSA and is associated with increased cerebral, cardiovascular and renal events. The aim of this study was to observe the effect of barnidipine calcium channel blocker on these patients.
  
  
  METHODS
  Forty-one patients (mean age 69 ± 17 years, 18 females) with previously diagnosed OSA (by reduced channel home-based polysomnography) who were not being treated with continuous positive airway pressure (CPAP) because of contraindications or because of patient intolerance or rejection were evaluated. Non-dipper status was defined as the presence of a nighttime fall in systolic blood pressure (BP) which was < 10% that of daytime systolic BP as observed in a previous ambulatory blood pressure (ABP) monitoring. OSA was defined according to the presence of 5 or more episodes per hour of apnoea, hypopnoea or arousal due to respiratory effort. The reproducibility of non-dipping status was confirmed through a second 24-h ABP monitoring performed at baseline. On top of the previous stable treatment regimen (which excluded calcium-channel blockers), a 10 mg dosing of barnidipine hydrochloride at bedtime was added to all subjects during a 12-week period.
  
  
  RESULTS
  Among the 41 non-dipper patients, 32 (78%) showed complete normalization of circadian rhythm. Add-on treatment with barnidipine was generally well tolerated.
  
  
  CONCLUSIONS
  Bedtime dosing of the calcium-channel blocker (CCB) barnidipine significantly reduced mean nighttime systolic and diastolic ABP in hypertensive patients presenting with non-dipper pattern and OSA--not on CPAP treatment. Moreover, it restored the previously altered circadian rhythm in the majority of them.
authors.affiliation: Department of Internal Medicine, Hypertension Unit, Guglielmo Da Saliceto Hospital, Piacenza, Italy. dorianzabzuni@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Crippa
authors.forename: D
authors.initials: D
authors.lastname: Zabzuni
authors.forename: A
authors.initials: A
authors.lastname: Cassi
authors.forename: E
authors.initials: E
authors.lastname: Bravi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000502:physiology; D045422:Continuous Positive Airway Pressure; D003971:Diastole; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017286:Polysomnography; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D013599:Systole
chemical_list: D002121:Calcium Channel Blockers; C050699:mepirodipine; D009543:Nifedipine