Subjective sleep quality during treatment with two different antihypertensive medications - Isradipine versus metoprolol

Objective: Only a few studies have addressed the effect of antihypertensive medication on the quality of sleep and sleep apnoea. Therefore, we evaluat ed the subjective sleep quality of hypertensive patients using self-adminis tered questionnaires (in particular factors reflecting sleep apnoea and sno ring) when treated with either metoprolol, a beta-blocking agent, or isradi pine, a calcium antagonist. Design and Patients: Seven hundred and ninety-seven men and women with dias tolic blood pressure (DBP) of 95 to 114mm Hg were randomised to receive eit her isradipine 1.25mg twice daily or metoprolol 50mg twice daily after a 4- week placebo washout period. The dosages were titrated at 4-week intervals to maintain normotension (DBP less than or equal to 90mm Hg). If normotensi on was not achieved by monotherapy, add-on therapy (combining isradipine an d metoprolol) was started. The patients completed a sleep questionnaire at the end of the placebo period and at 8 and 24 weeks on active treatment to evaluate the effect of these two medications on sleep. Results: After 8 weeks of monotherapy, isradipine showed a more favourable change in the number of naps taken (p < 0.05), the tendency to fall asleep during leisure time (p < 0.01) and the frequency of nocturnal sweating (p < 0.001) compared with metoprolol. However, most of the differences between the study drugs were reduced after 24 weeks of monotherapy; only nocturnal sweating (p < 0.05) still exhibited the same difference as that seen at 8 w eeks. With regard to the frequency of snoring, a more favourable change was observed with metoprolol (p < 0.05). Combining isradipine with metoprolol clearly decreased nocturnal sweating (p < 0.001). Conclusions: According to our study there were only small clinically non-si gnificant long-lasting differences between isradipine and metoprolol with r egard to their effect on sleep. Significant differences were seen at the be ginning of the treatment but they lessened during the course of the study.