Meta-analysis details different obstructive sleep apnea treatments for lowering BP
China: In patients with obstructive sleep apnea (OSA), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs) can effectively reduce blood pressure (BP), a research shows. Renal sympathetic denervation (RDN) is a novel hypertension treatment that lowered BP in such patients.
"CPAP might be helpful as adjunctive therapy in OSA patients with hypertension as it was associated with mild but stable BP reduction," Jing Yu, Lanzhou University Second Hospital, Hypertension Centre, Lanzhou, Gansu, China, and colleagues wrote in their study published in the Journal of Hypertension.
Obstructive sleep apnoea is a common cause of secondary hypertension. The researchers aimed to assess the effect of different OSA treatments on lowering blood pressure in a network meta-analysis (NMA).
For this purpose, the researchers searched the online databases for relevant randomized controlled trials. The search strategies included the concepts of OSA, hypertension, blood pressure, and blood pressure-reducing treatments without language or data restriction (from inception to 1 June 2021).
The outcomes included office DBP, office SBP, daytime SBP (dSBP) and DBP (dDBP), and DBP (nDBP) and night-time SBP (nSBP). The researchers performed a Bayesian network meta-analysis.
Salient findings of the study include:
- The researchers reviewed 49 randomized controlled trials involving 4893 patients and the following interventions: mandibular advancement devices, : continuous positive-airway pressure (CPAP), nocturnal supplemental oxygen, surgery, β-blocker, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), renal sympathetic denervation (RDN), calcium channel blockers.
- MRAs were significantly associated with blood pressure reduction followed by ACEI/ARB. RDN could reduce office SBP, office DBP, 24-h SBP, 24-h DBP, dSBP, and dDBP.
- CPAP also demonstrated modest blood pressure lowering.
"MRAs and ACEIs/ARBs can effectively reduce BP effectively in OSA patients. RDN is a novel hypertension treatment that lowered BP in such patients," the authors wrote in their study.
"CPAP was associated with mild but stable blood pressure reduction, and it might be helpful as an adjunctive therapy in OSA patients with hypertension."
Reference:
Kou, Chengkun∗; Zhao, Xu∗; Lin, Xin; Fan, Xin; Wang, Qiongying; Yu, Jing Effect of different treatments for obstructive sleep apnoea on blood pressure, Journal of Hypertension: June 2022 - Volume 40 - Issue 6 - p 1071-1084 doi: 10.1097/HJH.0000000000003131
