Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome
Obstructive sleep apnoea syndrome (O-SAS) induces excessive activity of the sympathetic nervous system, resulting in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first-line therapy for O-SAS, poor adherence to CPAP induces uncontrollable resistant hypertension....
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| Format: | Article |
| Language: | English |
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Elsevier España
2023-10-01
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| Series: | Medicina Clínica Práctica |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2603924923000319 |
| _version_ | 1797654721144553472 |
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| author | Ryuta Sugihara Yuusaku Sugihara Itsuko Sugihara Yasushi Sakata |
| author_facet | Ryuta Sugihara Yuusaku Sugihara Itsuko Sugihara Yasushi Sakata |
| author_sort | Ryuta Sugihara |
| collection | DOAJ |
| description | Obstructive sleep apnoea syndrome (O-SAS) induces excessive activity of the sympathetic nervous system, resulting in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first-line therapy for O-SAS, poor adherence to CPAP induces uncontrollable resistant hypertension. We present a case of O-SAS-related hypertension successfully treated with sacubitril/valsartan alone. Polysomnography before treatment showed a markedly increased apnoea-hypopnoea index (44.8/hour). While receiving treatment with CPAP and azilsartan, his in-office blood pressure remained within the acceptable range (120–130/80–85 mmHg). However, his blood pressure increased again after quitting CPAP. Subsequently, we switched to sacubitril/valsartan alone and succeeded in improving his blood pressure from 145/95 to 120/80 mmHg. Furthermore, sacubitril/valsartan improved sleep quality in terms of blood pressure (from non-dipper type to dipper type) and apnoea-hypopnoea index (38.3/hour). This case indicates that sacubitril/valsartan has great potential for antihypertensive effects in patients with severe O-SAS, even without CPAP. Resumen: El síndrome de apnea obstructiva del sueño (SAOS) induce actividad excesiva del sistema nervioso simpático, ocasionando hipertensión secundaria. Aunque la presión positiva continua en vía respiratoria (CPAP) es el tratamiento inicial para SAOS, mala adherencia a CPAP provoca hipertensión resistente incontrolable. Presentamos un caso de hipertensión relacionada con SAOS tratada exitosamente solo con sacubitril/valsartán. La polisomnografía pre-tratamiento mostró un índice de apnea-hipopnea notablemente aumentado (44,8/hora). Tratando con CPAP y azilsartán, su presión arterial en consultorio permaneció en rango aceptable (120-130/80-85 mmHg). Pero, su presión arterial volvió a aumentar tras dejar la CPAP. Posteriormente, cambiamos a solo sacubitril/valsartán, consiguiendo mejorar su presión arterial (de 145/95 a 120/80 mmHg). Además, sacubitril/valsartán mejoró la calidad de sueño durante el sueño en términos de presión arterial (tipo no dipper a tipo dipper) y del índice de apnea-hipopnea (38,3/hora). Este caso demuestra que sacubitril/valsartán tiene un gran potencial de efectos antihipertensivos en pacientes con SAOS grave, incluso sin CPAP. |
| first_indexed | 2024-03-11T17:03:37Z |
| format | Article |
| id | doaj.art-bc32ea8f1f9440068f546bbd2248a215 |
| institution | Directory Open Access Journal |
| issn | 2603-9249 |
| language | English |
| last_indexed | 2024-03-11T17:03:37Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier España |
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| series | Medicina Clínica Práctica |
| spelling | doaj.art-bc32ea8f1f9440068f546bbd2248a2152023-10-20T06:48:34ZengElsevier EspañaMedicina Clínica Práctica2603-92492023-10-0164100393Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndromeRyuta Sugihara0Yuusaku Sugihara1Itsuko Sugihara2Yasushi Sakata3International Sugihara Ophthalmology and Internal medicine Clinic, 751-1 Chayamachi, Kurashiki, Okayama 710-1101, Japan; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Corresponding author.International Sugihara Ophthalmology and Internal medicine Clinic, 751-1 Chayamachi, Kurashiki, Okayama 710-1101, JapanInternational Sugihara Ophthalmology and Internal medicine Clinic, 751-1 Chayamachi, Kurashiki, Okayama 710-1101, JapanDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanObstructive sleep apnoea syndrome (O-SAS) induces excessive activity of the sympathetic nervous system, resulting in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first-line therapy for O-SAS, poor adherence to CPAP induces uncontrollable resistant hypertension. We present a case of O-SAS-related hypertension successfully treated with sacubitril/valsartan alone. Polysomnography before treatment showed a markedly increased apnoea-hypopnoea index (44.8/hour). While receiving treatment with CPAP and azilsartan, his in-office blood pressure remained within the acceptable range (120–130/80–85 mmHg). However, his blood pressure increased again after quitting CPAP. Subsequently, we switched to sacubitril/valsartan alone and succeeded in improving his blood pressure from 145/95 to 120/80 mmHg. Furthermore, sacubitril/valsartan improved sleep quality in terms of blood pressure (from non-dipper type to dipper type) and apnoea-hypopnoea index (38.3/hour). This case indicates that sacubitril/valsartan has great potential for antihypertensive effects in patients with severe O-SAS, even without CPAP. Resumen: El síndrome de apnea obstructiva del sueño (SAOS) induce actividad excesiva del sistema nervioso simpático, ocasionando hipertensión secundaria. Aunque la presión positiva continua en vía respiratoria (CPAP) es el tratamiento inicial para SAOS, mala adherencia a CPAP provoca hipertensión resistente incontrolable. Presentamos un caso de hipertensión relacionada con SAOS tratada exitosamente solo con sacubitril/valsartán. La polisomnografía pre-tratamiento mostró un índice de apnea-hipopnea notablemente aumentado (44,8/hora). Tratando con CPAP y azilsartán, su presión arterial en consultorio permaneció en rango aceptable (120-130/80-85 mmHg). Pero, su presión arterial volvió a aumentar tras dejar la CPAP. Posteriormente, cambiamos a solo sacubitril/valsartán, consiguiendo mejorar su presión arterial (de 145/95 a 120/80 mmHg). Además, sacubitril/valsartán mejoró la calidad de sueño durante el sueño en términos de presión arterial (tipo no dipper a tipo dipper) y del índice de apnea-hipopnea (38,3/hora). Este caso demuestra que sacubitril/valsartán tiene un gran potencial de efectos antihipertensivos en pacientes con SAOS grave, incluso sin CPAP.http://www.sciencedirect.com/science/article/pii/S2603924923000319síndrome de apnea obstructiva del sueñohipertensiónsacubitril/valsartán |
| spellingShingle | Ryuta Sugihara Yuusaku Sugihara Itsuko Sugihara Yasushi Sakata Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome Medicina Clínica Práctica síndrome de apnea obstructiva del sueño hipertensión sacubitril/valsartán |
| title | Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome |
| title_full | Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome |
| title_fullStr | Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome |
| title_full_unstemmed | Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome |
| title_short | Successful antihypertensive treatment using sacubitril/valsartan alone in a patient with obstructive sleep apnoea syndrome |
| title_sort | successful antihypertensive treatment using sacubitril valsartan alone in a patient with obstructive sleep apnoea syndrome |
| topic | síndrome de apnea obstructiva del sueño hipertensión sacubitril/valsartán |
| url | http://www.sciencedirect.com/science/article/pii/S2603924923000319 |
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