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Periodic Limb Movements Increase With Isradipine, Decrease With Atenolol: Presented at ASH(HYP)

By Maggie Schwarz

NEW YORK, NY -- May 21, 2003 -- Periodic limb movements during sleep are increased with use of a calcium channel blocker, while beta blockers, such as atenolol, appear to reduce them.

Periodic limb movements (PLM) are stereotyped repetitive muscle jerks in the extremities during sleep. Iikka Kantola, MD, and colleagues, from Turku University Central Hospital, Finland, looked for an antihypertensive that would reduce PLMs, and presented their results here at the 18^th Annual Scientific Meeting of the American Society of Hypertension.

Dr. Kantola said that at least half of patients with hypertension have sleep apnea. Nocturnal PLMs are connected to sleep apnea, and can disturb deep sleep resulting in lack of deep sleep.

Fifteen patients with upper airway obstruction took atenolol 50 mg, hydrochlorothiazide 25 mg, the calcium antagonist isradipine 2.5 mg, and the angiotensin converting enzyme inhibitor spirapril 6 mg, in double-blind crossover fashion, once a day for 8 weeks, with a 2 to 3 week washout period between each medication. A sleep study employed the static charge sensitive bed method. The amount of PLMs was visually analyzed, and calculated as the percentage of time in bed.

Spirapril and atenolol reduced PLMs, with no significant difference between the 2 agents. Hydrochlorothiazide and isradipine increased them. The difference between the reduction in PLMs induced by atenolol, and the increase in PLMs induced by isradipine was significant, at (P=.05).

Dr. Kantola said that hypertensives with sleep apnea are difficult to treat, and often require 3 or more medications. Since completing the study, Dr. Kantola doesn't start with a calcium antagonist in these patients, but uses one only as the 3rd or 4th medication.


[Study title: Atenolol as Antihypertensive Treatment Decreases Nocturnal Periodic Limb Movements (PLM) More Than Isradipine SR in Hypertensive Sleep Apneic Patients. Abstract P-224]

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