THE BENEFITS OF ANGIOTENSIN II RECEPTOR ANTAGONISTS I TYPE IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

Objective. To assess efficiency of angiotensin II converting enzyme inhibitor Perindopril versus angiotensin II receptor blocker Telmisartan in hypertensive patients with obstructive sleep apnea syndrome (OSAS).

Design and methods. Sixty hypertensive patients with OSAS (non-CPAP-users) were enrolled in a randomized controlled open study: 48 males and 12 females; mean age — 56,2 ± 9,5 years; hypertension duration — 12,5 ± 7,4 years; body mass index — 32,0 ± 5,9 kg/m2, apnea-hypopnea index (AHI) — 35,4 ± 24,2 episodes per hour of sleep. All patients were divided into 2 groups: patients (n = 30) from the 1st group got Telmisartan 40 mg daily (titrated up to 80 mg daily if necessary), and Perindopril 4 mg daily (titrated up to 8 mg daily) was prescribed to 2nd group (n = 30). The treatment lasted for 12 weeks.

 Results. Twenty three patients in Telmisartan group and 24 patients in Perindopril group achieved goal blood pressure (< 140/90 mmHg) (χ2 = 1,23; p > 0,05), all patients got maximal doses of medications. The reduction of offi ce and 24-hour blood pressure was comparable in both groups. Circadian blood pressure profi le was normalized in 17 patients from Telmisartan group and in 9 patients from Perindopril group (χ2 = 6,21; p < 0,05). At the same time AHI decreased by 19 episodes per hour of sleep in Telmisartan group, while it increased by 10,1 episodes per hour of sleep in Perindopril group (p < 0,01).

Conclusion. Telmisartan treatment is beneficial in hypertensive obese patients with OSAS compared to Perindopril due to the reduction of OSAS severity (assessed by AHI) leading to the normalization of circadian blood pressure profile. 

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