AIMS: We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). METHODS AND RESULTS: Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, apnoea-hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin-angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders. CONCLUSION: In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.

Cardiology Unit Sleep Center IRCCS Istituto Auxologico Italiano Milan Italy

Center for Research and Innovation in Precision Medicine and Pharmacy 'Victor Babes' University of Medicine and Pharmacy Timisoara Romania

Center for Sleep and Vigilance Disorders Sahlgrenska Academy Gothenburg University Medicinaregatan 8B Box 421 405 30 Gothenburg Sweden

Department of Chest Diseases Ege University Izmir Turkey

Department of Internal Medicine University Hospital Brno Brno Czech Republic

Department of Medicine and Surgery University of Milano Bicocca Milan Italy

Department of Sleep Medicine Sahlgrenska University Hospital Blå stråket 5 413 45 Gothenburg Sweden

Respiratory Failure Unit G Papanikolaou Hospital Aristotle University of Thessalonikii Thessalonikii Greece

Sleep Disorders Center St Adolf Stift Reinbeck Germany

Sleep Disorders Centre University Hospital Gasthuisberg Leuven Belgium

Sleep Disorders Unit Department of Respiratory Medicine School of Medicine University of Crete Crete Greece

Unità Operativa di Medicina del Sonno Istituto Scientifico di Pavia IRCCS Pavia Italy

Université Grenoble Alpes INSERM HP2 and Grenoble University Hospital Grenoble France

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