EFFECT OF DIFFERENT TREATMENT OF HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA ON BLOOD PRESSURE: A NETWORK META-ANALYSIS

Abstract

Objective: OSA is one of the common causes of secondary hypertension. The antihypertensive treatment include pharmacotherapy and non-pharmacotherapy. However, the effect of different treatment on blood pressure is still unclear. Theaim of this study was to compare the effect of pharmacotherapy and non-pharmacotherapy for obstructive sleep apnea on blood pressure. Design and method: We searched PubMed, EMBASE, Web of Science, Cochrane Library database, China Biology Medicine disc (up to June 1, 2021) to identify the studies that met the inclusion criteria. Two reviewers independently screened literature, extracted data, and assessed the risk of bias. R software was used to perform the meta-analysis. Results: A total of 30 clinical trials involving 3483 patients were included. Angiotensin-Converting Enzyme Inhibitors(ACEI) /Angiotensin receptor blockers(ARB) showed the most significant antihypertensive effects on office systolic blood pressure as compared with placebo (MD = -4.56, 95%CI: -27.53~-1.69). Mineralocorticoid receptor antagonist (MRA) showed the most significant antihypertensive effects on office diastolic blood pressure as compared with placebo (MD = -15.02, 95%CI: -24.35~-5.72). Rankogram also shows the ACEI/ ARB is the best treatment on office systolic blood pressure and MRA is the best treatment on office diastolic blood pressure. Conclusions: For hypertensive patients with obstructive sleep apnea, Renin-angiotensin-aldosterone System inhibitor (RAS-I) may be the optimal antihypertensive treatment.