Beta blockers plus diuretic tied to lowest SBP in OSA patients

Obstructive sleep apnoea (OSA) patients on antihypertension medication often have poorly controlled blood pressure (BP), reveals a study. Treatment with beta blockers alone or in combination with a diuretic appears to result in the lowest systolic (S)BP in this clinical cohort.

The authors analysed 5,818 hypertensive OSA patients (mean age, 58 years; body mass index, 33 kg/m²; apnoea hypopnea index, 34 events/h) receiving BP-lowering treatment in the European Sleep Apnea Database. They also classified medications (eg, beta blockers, diuretic, renin-angiotensin blocker [RAB], calcium channel blocker [CCB], and centrally acting antihypertensive [CAH]) according to the Anatomical Therapeutic Chemical code. Office BP was then compared in patients with monotherapy or combination therapy controlling for confounders.

Of the patients, 66 percent had poorly controlled SBP according to the ESC/ESH guidelines. Those on monotherapy with RAB, CCB, or CAH had 2.2- (95 percent confidence interval [CI], 1.04–3.0; p=0.007), 3.0- (95 percent CI, 1.9–4.1; p=0.008), and 3.0-mm Hg (95 percent CI, 1.7–4.7; p=0.017) higher SBP, respectively, than those on beta blockers.

Among patients receiving a combination of two antihypertensive drugs, SBP was 5.5- (95 percent CI, 4.0–7.1; p<0.001), 5.1- (95 percent CI, 3.7–6.6; p<0.001), 4.3- (95 percent CI, 2.5–6.1; p=0.018), and 3.1-mm Hg (95 percent CI, 1.6–4.6; p=0.036) higher than those on beta blocker–diuretic combination.

“Arterial hypertension is highly prevalent and difficult to control in patients with OSA,” the authors said. “High sympathoadrenergic activity is a hallmark physiological phenomenon in OSA.”