ARTERIAL-HYPERTENSION AND SLEEP APNEA - EFFECT OF THE ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITOR CILAZAPRIL ON CONTINUOUSLY MEASURED BLOOD-PRESSURE DURING SLEEP AND WAKEFULNESS

Male patients with arterial hypertension and obstructive sleep-related breathing disorders (mean age 50 y, Body Mass Index (BMI) 32.4 kg m(- 2), Respiratory Disturbance Index (RDI) 47.2 and systolic/diastolic bl ood pressure (SBD/DBD) 162/103 mmHg) were examined before and after 8 days of treatment with the long-acting angiotensin-converting-enzyme ( ACE) inhibitor cilazapril 2.5 mg vs. placebo in a double-blind design with parallel groups. Cardiorespiratory polysomnography was carried ou t at night; during daytime wakefulness patients submitted to examinati ons of physical and mental exertion. Cilazapril reduced the mean press ure during the entire examination period (day and night) by 9.55 (SD /-7.13) mmHg, compared to 4.57 (SD +/-7.20) mmHg for placebo (P < 0.00 6), independently from systematic changes of heart rate (x = -3.3 and -3.5 bpm, respectively). During REM sleep, mean arterial pressure was significantly reduced by 8.63 (SD +/-10.1) mmHg, compared to a reducti on on placebo of 3.17 (SD 9.6) mmHg (P = 0.023). Under psychometric st rain, the mean arterial pressure was reduced by 15.31 (SD +/-8.7) mmHg with cilazapril; under placebo medication by 6.19 (SD +/-7.3) mmHg (P < 0.0001). Heart rate was not significantly changed.