PURPOSE: To assess the effects of N-type calcium channel blocker (CCB), Cilnidipine, which has an inhibitory effect of sympathetic nervous activity, and continuous positive airway pressure (CPAP) on morning hypertension complicated with more than moderate degree of sleep apnea (SA).
METHODS: The subjects were 19 patients with morning hypertension (≧135/85mmHg) by ambulatory blood pressure monitoring (ABPM) and more than moderate degree of SA (Apnea hypopnea index (AHI:/h) ≧15). Cilnidipine was administered to 9 patients with 15≦AHI<20, or AHI≧20 and rejection of CPAP (Cilnidipine group). Ten patients accepted treatment of CPAP (CPAP group). Before and after 6 months of Cilnijipin (10mg/day) and CPAP, blood pressure (BP) of office and ABPM, SA indexes, sympathetic nervous activity, and echocardiography were examined.
RESULTS: In Cilnidipine group, Office BP (mmHg) decreased significantly from 154/92 (Control;C) to 130/74 after 6 months (6M). Morning and average BP by ABPM decreased from (C) 160/80 and 150/87 to (6M) 130/73 and 136/78, respectively. The AHI improved from (C) 19.4 to (6M) 12.4 (p<0.05). Nocturnal urinary noradrenaline had reduced tendency from (C) 93 to (6M) 63 (p=0.16). No other index showed significant difference. In CPAP group, systolic office and morning BP had decreased tendency from (C) 148/84 and 152/85 to (6M) 136/77 and 136/80, respectively. No difference was seen in average BP. AHI decreased significantly from (C) 41 to (just after CPAP) 5 (p<0.005) and (6M CPAP) 7 (p<0.005).
CONCLUSIONS: Six months of Cilnidipine, which has inhibitory effects of sympathetic nervous activity, administration improved the office BP, morning and average BP by ABPM, and AHI in patients with morning hypertension and more than moderate degree of SA. CPAP improved SA and had decreased tendency of systolic office BP and morning BP by ABPM in these patients.
CLINICAL IMPLICATIONS: Both Cilnidipine and CPAP are useful for treating morning hypertension complicated with more than moderate degree of SA.
DISCLOSURE: The following authors have nothing to disclose: Hitoshi Koito, Maiko Seo, Rika Kubo, Akihiko Takahashi, Miwako Satoh
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