24-HOUR BLOOD-PRESSURE CONTROL - EFFECT OF CILAZAPRIL ON CONTINUOUS ARTERIAL BLOOD-PRESSURE DURING SLEEP, AND PHYSICAL AND MENTAL LOAD IN PATIENTS WITH ARTERIAL-HYPERTENSION AND SLEEP-APNEA

To assess the effectiveness of cilazapril in regulating blood pressure (BP) in patients with sleep-related breathing disorders, 23 male pati ents (mean age, 50 years; mean body mass index, 32.7 kg/m(2)) with a m ean apnea/hypopnea index of 49.7 and arterial hypertension (163/104 mm Hg) participated in a placebo-controlled, randomized, double-blind st udy. They received either cilazapril, 2.5 mg/day (n = 12) or placebo ( n = 11). The effects of treatment were studied under different conditi ons of sleep and physical and mental load before and after 8 days of t reatment. Measurements by night included cardiorespiratory polysomnogr aphy, inductive plethysmography, pulse oximetry and nasal air flow, el ectroencephalography, (EEG), electrooculography and electromyography, (ECG), and blood pressure (BP). Measurements by day (ECG, heart rate, and BP) were performed at rest and under physical and mental load. Sys tolic, diastolic, and mean BP (5 min at night; 1 s during the day), he art rate, apnea and hypopnea index, EEG data, and test reaction times were compared in both groups. The systolic and diastolic BP of patient s receiving cilazapril was lower compared to baseline for all physical and mental loads. Mean BP reductions over all standardized loads was greater with cilazapril than placebo (-10 vs. -4.3 mm Hg, p < 0.05). T hese results show that BP is influenced similarly by mental and physic al loads, and that behavior [i.e., awake state and non-rapid eye movem ent and rapid eye movement (NREM and REM) sleep determines BP regulati on. Cilazapril is effective in reducing BP in all situations, especial ly during REM sleep hypertension.