By Betty S. Riggs
SAN DIEGO -- November 6, 2009 -- Valsartan produced a 3-fold higher decrease in blood pressure than did continuous positive airway pressure (CPAP) in the treatment of hypertensive patients with sleep apnoea, according to study results presented here at CHEST 2009, the annual meeting of the American College of Chest Physicians.
Jean-Louis Pepin, MD, PhD, Joseph Fourier University, Grenoble, France, and colleagues reported their findings here on November 3.
This crossover trial randomised 28 previously untreated patients with hypertension and obstructive sleep apnoea (mean age 57 years, 82.6% male) to either CPAP (n = 14) or valsartan 160 mg (n = 14) during the first 8-week treatment period. After a 4-week washout period, the patients received the alternative therapy during the second 8-week period. The mean clinic blood pressure (BP) at baseline was 154.9/102.2 mm Hg. Mean 24-hour BP was the primary outcome variable, and prior to and at the end of each treatment period, a 24-hour BP measurement was obtained.
Prior to treatment with CPAP, the 24-hour mean BP was 104.4 +- 8.5 mm Hg and after 8 weeks of treatment with CPAP the 24-hour mean BP was 102.3 +- 10.9 mm Hg. There was a significant difference of -7.00 mm Hg in mean 24-hour BP reduction between the 2 treatments (P < .001).
Prior to treatment with valsartan, the 24-hour mean BP was 104.8 +-8.1 mm Hg and after 8 weeks of treatment with valsartan 9 the 24-hour mean BP was 5.7 +- 8.5 mm Hg.
Twenty-three patients completed both treatment arms and were included in the intention-to-treat (ITT) analysis.
Patients with uncontrolled BP at the end of the trial could continue in an 8-week open-label extension.
During the open-label extension, 11 patients with uncontrolled BP continued therapy. The combination of valsartan and CPAP resulted in a greater reduction in 24-hour mean BP than did either treatment as monotherapy. Combination therapy produced a 24-hour mean BP of 93.4 +- 7.6 mm Hg compared with 95.8 +- 6.0 mm Hg with valsartan alone and 102.3 +- 8.8 mm Hg with CPAP alone (P = .005).
According to Dr. Pepin, this study suggests that most patients with obstructive sleep apnoea may not be adequately treated for hypertension when using CPAP alone.
[Presentation title: Comparison of Continuous Positive Airway Pressure and Valsartan 160 mg in Hypertensive Sleep Apnea Patients Never Treated for Both Conditions: The VALSAS Study]
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