Comparison of atenolol, amlodipine, enalapril, hydrochlorothiazide, and losartan for antihypertensive treatment in patients with obstructive sleep apnea

We compared the effects of atenolol (50 mg), amlodipine (5 mg), enalapril ( 20 mg), hydrochlorothiazide (25 mg), and losartan (50 mg) given in once-dai ly oral doses on office and ambulatory blood pressures (BPs) in patients wi th hypertension and obstructive sleep apnea (OSA). Each of 40 randomized pa tients was treated in sequence with two of the five agents (balanced incomp lete block design). Treatment periods lasted 6 wk and were separated by a 3 -wk washout period. Changes in BP from baseline with the study substances w ere compared through analysis of variance. Office diastolic BP, our primary outcome variable, was most effectively lowered by atenolol, with all four post hoc differences between atenolol and the remaining substances being st atistically significant. Reductions in office systolic and daytime ambulato ry BP were not significantly different among the five compounds. However, a tenolol reduced mean nighttime ambulatory diastolic and systolic BP more ef fectively than did amlodipine, enalapril, or losartan (but not hydrochlorot hiazide). Severity of sleep-disordered breathing and well-being during the day were not significantly influenced by any of the study compounds. Our fi ndings are in accordance with the hypothesis that an overactivity of the sy mpathetic nervous system is an important mechanism behind the development o r maintenance of hypertension in patients with OSA.