Current opinion in nephrology and hypertensionFeb 18, 2011

Blood Pressure Treatment for People with Obstructive Sleep Apnea

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 28, 2026

Abstract

Obstructive sleep apnea (OSA) is associated with hypertension that is often resistant to treatment.

Sleep apnea frequently occurs alongside metabolic syndrome and kidney issues.
Atrial natriuretic peptide release and heightened sympathetic nerve activity during the day may contribute to OSA-related hypertension.
β-1 adrenergic blockers have shown a greater reduction in blood pressure compared to thiazide diuretics in OSA patients.
ACE inhibitors and angiotensin II blockers have demonstrated similar effectiveness in some studies for managing hypertension in OSA.
Spironolactone has been effective in patients with OSA who experience treatment-resistant hypertension.

Simplified

PURPOSE OF REVIEW: Patients with obstructive sleep apnea (OSA) often have hypertension that is difficult to control. We review the causes of OSA hypertension and evidence supporting specific therapies.

RECENT FINDINGS: Sleep apnea commonly accompanies the metabolic syndrome and renal insufficiency. Apneas stimulate atrial natriuretic peptide release and sympathetic nerve activity, which persists throughout the daytime. The combination of increased sympathetic nerve activity and a nocturnal diuresis help explain reports that β-1 antagonists lower blood pressure more than thiazide diuretics in OSA. The angiotensin-converting enzyme (ACE) inhibitors and angiotensin II blocking drugs have been equally effective in some studies. Patients with treatment-resistant hypertension usually have OSA and have had a good antihypertensive response to spironolactone.

SUMMARY: Although most elderly hypertensives respond to diuretics and calcium channel blockers, patients with OSA responded to β-1 adrenergic blockers, ACE inhibitors, and angiotensin II blocking drugs. The response to a second drug is not known. However, many patients with OSA remain hypertensive on three antihypertensive agents, in which case the addition of spironolactone has been effective. It is reasonable to prescribe shorter acting antihypertensive drugs at night to treat nocturnal hypertension.

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Blood Pressure Treatment for People with Obstructive Sleep Apnea

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