Abstract：
BACKGROUND: Obstructive sleep apnea (OSA) and hypertension are common conditions that may be linked through sympathetic activation and water retention. We hypothesized that diuretics, which reduce the body water content, may be more effective than amlodipine, a blood pressure (BP)-lowering agent implicated with edema, in controlling OSA in patients with hypertension. We also aimed to compare the effects of these treatments on ambulatory blood pressure monitoring (ABPM).
METHODS: In a randomized, double-blind clinical trial, we compared the effects of chlorthalidone/amiloride 25/5 mg with amlodipine 10 mg on OSA measured by portable sleep monitor and BP measured by ABPM. The study included participants older than 40 who had moderate OSA (10-40 apneas/hour of sleep) and BP within the systolic range of 140-159 mmHg or diastolic range of 90-99 mmHg.
RESULTS: The individuals in the experimental groups were comparable in age, gender, and other relevant characteristics. Neither the combination of diuretics nor amlodipine alone reduced the AHI after 8 weeks of treatment (AHI 26.3 with diuretics and 25.0 with amlodipine. P = 0.713). Both treatments significantly lowered office, 24-h, and nighttime ABP, but the two groups had no significant difference.
CONCLUSIONS: Chlorthalidone associated with amiloride and amlodipine are ineffective in decreasing the frequency of sleep apnea episodes in patients with moderate OSA and hypertension. Both treatments have comparable effects in lowering both office and ambulatory blood pressure. The notion that treatments could offer benefits for both OSA and hypertension remains to be demonstrated. TRIAL REGISTRATION CLINICALTRIALS.
UNASSIGNED: NCT01896661.
METHODS: In a randomized, double-blind clinical trial, we compared the effects of chlorthalidone/amiloride 25/5 mg with amlodipine 10 mg on OSA measured by portable sleep monitor and BP measured by ABPM. The study included participants older than 40 who had moderate OSA (10-40 apneas/hour of sleep) and BP within the systolic range of 140-159 mmHg or diastolic range of 90-99 mmHg.
RESULTS: The individuals in the experimental groups were comparable in age, gender, and other relevant characteristics. Neither the combination of diuretics nor amlodipine alone reduced the AHI after 8 weeks of treatment (AHI 26.3 with diuretics and 25.0 with amlodipine. P = 0.713). Both treatments significantly lowered office, 24-h, and nighttime ABP, but the two groups had no significant difference.
CONCLUSIONS: Chlorthalidone associated with amiloride and amlodipine are ineffective in decreasing the frequency of sleep apnea episodes in patients with moderate OSA and hypertension. Both treatments have comparable effects in lowering both office and ambulatory blood pressure. The notion that treatments could offer benefits for both OSA and hypertension remains to be demonstrated. TRIAL REGISTRATION CLINICALTRIALS.
UNASSIGNED: NCT01896661.
摘要：
背景：阻塞性睡眠呼吸暂停（OSA）和高血压是常见的疾病，可能与交感神经激活和水潴留有关。我们假设利尿剂，减少身体含水量，可能比氨氯地平更有效，一种与水肿有关的降血压药，控制高血压患者的OSA。我们还旨在比较这些治疗方法对动态血压监测（ABPM）的影响。
方法：在随机分组中，双盲临床试验,我们比较了氯噻酮/阿米洛利25/5mg与氨氯地平10mg对便携式睡眠监测仪测量的OSA和ABPM测量的BP的影响。该研究包括40岁以上的参与者，他们患有中度OSA（10-40呼吸暂停/小时睡眠），血压在140-159mmHg的收缩压范围或90-99mmHg的舒张压范围内。
结果：实验组中的个体年龄相当，性别,和其他相关特征。治疗8周后，利尿剂和氨氯地平的组合均未降低AHI（利尿剂的AHI26.3和氨氯地平的A5.0。P=0.713）。两种治疗方法都大大降低了办公室，24小时,和夜间ABP,但两组差异无统计学意义。
结论：氯噻酮联合阿米洛利和氨氯地平在降低中度OSA和高血压患者睡眠呼吸暂停发作频率方面无效。两种治疗方法在降低办公室和动态血压方面具有相当的效果。治疗可以为OSA和高血压提供益处的观点仍有待证明。审判注册临床试验。
■NCT01896661。
方法：在随机分组中，双盲临床试验,我们比较了氯噻酮/阿米洛利25/5mg与氨氯地平10mg对便携式睡眠监测仪测量的OSA和ABPM测量的BP的影响。该研究包括40岁以上的参与者，他们患有中度OSA（10-40呼吸暂停/小时睡眠），血压在140-159mmHg的收缩压范围或90-99mmHg的舒张压范围内。
结果：实验组中的个体年龄相当，性别,和其他相关特征。治疗8周后，利尿剂和氨氯地平的组合均未降低AHI（利尿剂的AHI26.3和氨氯地平的A5.0。P=0.713）。两种治疗方法都大大降低了办公室，24小时,和夜间ABP,但两组差异无统计学意义。
结论：氯噻酮联合阿米洛利和氨氯地平在降低中度OSA和高血压患者睡眠呼吸暂停发作频率方面无效。两种治疗方法在降低办公室和动态血压方面具有相当的效果。治疗可以为OSA和高血压提供益处的观点仍有待证明。审判注册临床试验。
■NCT01896661。
