Arterial hypertension and sleep apnoea: effect of the angiotensin-converting enzyme (ACE) Inhibitor cilazapril on continuously measured blood pressure during sleep and wakefulness

SUMMARY  Male patients with arterial hypertension and obstructive sleep-related breathing disorders (mean age 50 y, Body Mass Index (BMI) 32.4 kg m^-2, Respiratory Disturbance Index (RDI) 47.2 and systolic/diastolic blood pressure (SBD/DBD) 162/103 mmHg) were examined before and after 8 days of treatment with the long-acting angiotensin-converting-enzyme (ACE) inhibitor cilazapril 2.5 mg vs. placebo in a double-blind design with parallel groups. Cardiorespiratory polysom-nography was carried out at night; during daytime wakefulness patients submitted to examinations of physical and mental exertion. Cilazapril reduced the mean pressure during the entire examination period (day and night) by 9.55 (SD±7.13) mmHg, compared to 4.57 (SD ±7.20) mmHg for placebo ( P < 0.006), independently from systematic changes of heart rate ( x = -3.3 and -3.5 bpm, respectively). During REM sleep, mean arterial pressure was significantly reduced by 8.63 (SD ±10.1) mmHg, compared to a reduction on placebo of 3.17 (SD 9.6) mmHg ( P = 0.023). Under psychometric strain, the mean arterial pressure was reduced by 15.31 (SD ±8.7) mmHg with cilazapril; under placebo medication by 6.19 (SD ±7.3) mmHg ( P < 0.0001). Heart rate was not significantly changed.