Comparison of Telmisartan vs. Valsartan in the Treatment of Mild to Moderate Hypertension Using Ambulatory Blood Pressure Monitoring

A prospective, randomized, open-label, blinded end-point trial compared telmisartan and valsartan for treating mild to moderate hypertension. Efficacy for 24-hour control of blood pressure was assessed using ambulatory blood pressure monitoring. Mean changes in diastolic blood pressure for the last 6 hours before dosing and the nighttime period were significantly greater with telmisartan than with valsartan (p<0.01 for the last 6 hours before dosing; p<0.05 for the nighttime period). Mean changes in systolic and diastolic blood pressures for the 24-hour interval, the morning, and the daytime periods were significantly greater with telmisartan than with valsartan (p<0.01). The incidence of all adverse events and the most common adverse events were comparable for patients receiving telmisartan and patients receiving valsartan. Neither treatment was associated with cough. These data suggest greater efficacy for telmisartan than valsartan in controlling blood pressure throughout the 24-hour dosing interval, including the last 6 hours before dosing, and the two agents were similarly well tolerated.     

Comparison of Telmisartan vs. Valsartan in the Treatment of Mild to Moderate Hypertension Using Ambulatory Blood Pressure Monitoring

A prospective, randomized, open-label, blinded end-point trial compared telmisartan and valsartan for treating mild to moderate hypertension. Efficacy for 24-hour control of blood pressure was assessed using ambulatory blood pressure monitoring. Mean changes in diastolic blood pressure for the last 6 hours before dosing and the nighttime period were significantly greater with telmisartan than with valsartan (p<0.01 for the last 6 hours before dosing; p<0.05 for the nighttime period). Mean changes in systolic and diastolic blood pressures for the 24-hour interval, the morning, and the daytime periods were significantly greater with telmisartan than with valsartan (p<0.01). The incidence of all adverse events and the most common adverse events were comparable for patients receiving telmisartan and patients receiving valsartan. Neither treatment was associated with cough. These data suggest greater efficacy for telmisartan than valsartan in controlling blood pressure throughout the 24-hour dosing interval, including the last 6 hours before dosing, and the two agents were similarly well tolerated.     

Urinary Sodium Excretion and Ambulatory Blood Pressure Findings in Patients With Hypertension

Use of ambulatory blood pressure (BP) monitoring (ABPM) allows for identification of dipping, nondipping, extreme dipping, and reverse dipping of BP. Using office BP and ABPM, hypertension subtypes can be identified: sustained normotension (SNT), white‐coat hypertension, masked hypertension, and sustained hypertension. The comparison of hemodynamic parameters and salt intake has not been investigated among these patient groups. Office BP, ABPM, augmentation index (AIx), pulse wave velocity (PWV), cardiac output (CO), and total peripheral resistance (TPR) were automatically measured. Estimation of salt intake was assessed by 24‐hour urinary sodium excretion. Urinary sodium excretion was not different among groups. AIx, PWV, CO, and TPR were lowest in patients with SNT. CO was lowest while AIx adjusted for a heart rate of 75 beats per minute, PWV, and TPR were highest in the extreme dipper group. No relationship was detected between hypertension subtypes and urinary sodium excretion.     

Ambulatory Blood Pressure Monitoring in Hypertension

Ambulatory blood pressure monitoring generates a greater interest among investigators and clinicians because of its potential to 1) study the mechanisms involved in cardiovascular control in daily life (particularly if monitoring is performed on a beat-to-beat basis) and 2) improve the diagnosis of hypertension, the estimate of the patient's risk and the assessment of the efficacy of antihypertensive treatment. This paper will discuss the evidence pros and cons the latter indications of this approach. It will be shown that 24 hour blood pressure values correlate more closely than clinic blood pressure with various measures of the end organ damage of hypertension, suggesting that it may reflect better than traditional blood pressure measurements the cardio-vascular consequences of this condition. Wider use of ambulatory blood pressure monitoring in the medical practice, however, must await a more clear demonstration of its prognostic importance, by longitudinal studies based on cardiovascular morbidity and mortality or on surrogate end points with undisputable clinical significance (e.g. left ventricular hypertrophy). It must also await clear definition of ambulatory blood pressure normality based on population studies. Until then ambulatory blood pressure monitoring should be employed to resolve special problems, e.g. identification of white coat hypertension and false non response to treatment.     

Discrepancy Between Tonometric Ambulatory and Cuff-Based Office Blood Pressure Measurements in Patients With Type 1 Diabetes

J Clin Hypertens (Greenwich). 2012;14:686–693. ©2012 Wiley Periodicals, Inc. The aim of the current study was to compare ambulatory blood pressure (ABP) with office blood pressure (OBP) in diagnosing hypertension (HTN) in type 1 diabetes. The cross-sectional study included 569 type 1 diabetes patients, with a mean±standard deviation (SD) age of 55±13 years and diabetes duration of 33±16 years, and 315 (55%) men. Blood pressure ≥130/80 mm Hg defined HTN. ABP was measured by tonometry and OBP by sphygmomanometry. Elevated ABP with normal OBP defined masked uncontrolled HTN, and normal ABP with elevated OBP defined isolated uncontrolled clinic HTN. Mean±SD 24-hour ABP, daytime ABP, and OBP was 128±16/75±10 mm Hg, 133±16/77±11 mm Hg, and 136±14/76±8 mm Hg, respectively (P<.001). With 24-hour and daytime ABP, HTN was present in 256 (45%) and 304 (53%) patients; normal BP in 102 (18%) and 88 (15%) patients; isolated uncontrolled clinic HTN in 154 (27%) and 104 (%) patients; and masked uncontrolled HTN in 57 (10%) and 73 (13%) patients. Twenty-four–hour ABP and OBP showed disagreement in diagnosing HTN in 211 (37%) patients. Daytime ABP and OBP disagreed in 177 (31%) patients. HTN by 24-hour and daytime ABP was present in 313 (55%) and 377 (66%) patients. ABP measurements were well-tolerated and successful in 98%. A total of 92% would volunteer for repeat measurements and 83% preferred the tonometry to conventional cuff-based devices. In patients with type 1 diabetes, tonometric ABP measurements are feasible. ABP and OBP disagree in diagnosing HTN in 31% to 37% of patients. Furthermore, 55% to 66% of patients do not reach target BP of <130/80 mm Hg despite regular follow-up.     

Visit-to-Visit and Ambulatory Blood Pressure Variability as Predictors of Incident Cardiovascular Events in Patients With Hypertension

BackgroundVisit-to-visit blood pressure variability (BPV) has been shown to be a prognostic indicator in hypertensive patients. We designed this study to clarify the impacts of clinic and ambulatory BPV in predicting cardiovascular disease (CVD).MethodsWe performed ambulatory BP monitoring (ABPM) in 457 hypertensive patients. Visit-to-visit BPV and ambulatory BPV were calculated as the SDs of clinic BP, awake BP, and sleep BP. The mean age of the subjects was 67.0 ± 9.2 years, and they were followed for 67 ± 26 months. Stroke, myocardial infarction, and sudden cardiac death were defined as Hard CVD events, and these plus angina, heart failure, and other CVDs were defined as All CVD events. Multivariable Cox hazard regression models predicting CVD events were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI) for different measures of BPV with adjustment for significant covariates.ResultsIn multivariable analyses, the BPV of clinic systolic BP (SBP) was an independent predictor for All CVD events (HR, 2.20; 95% CI, 1.25-3.88; P < 0.01), but not for Hard CVD events (P = 0.20). On the other hand, the BPV of sleep SBP was an independent predictor for Hard CVD events (HR, 2.21; 95% CI, 1.08-4.53; P = 0.03), but not for All CVD events (P = 0.88). Diastolic BPV exhibited the same pattern.ConclusionsThese findings suggest that visit-to-visit BPV and ambulatory BPV are separately useful in predicting cardiovascular outcomes.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.75.     

高血压病人动脉顺应性与家庭偶测血压及动态血压关系

目的探讨原发性高血压病人家庭测量血压、动态血压与动脉顺应性的关系.方法共入选164例受试者,其中原发性高血压组74例[男42例,女32例,平均年龄(47.05±10.08)岁];对照组90例[男41例,女49例,平均年龄(33.81±12.35)岁].对人选者间隔1～3周进行二次家访,每次家访由经过专门训练的护士采用汞柱血压计连续测量受试者坐位、左上臂血压5次,每人的家庭测量血压是二次家访、共10个血压读数的平均值.同时采用SpaceLsbs 90207动态血压监测仪记录24小时动态血压,有效数据应达到80%以上.动脉顺应性检查采用动脉脉搏波分析(PWA)仪.反映大动脉硬化的参数为反射波增强指数(AIx).结果高血压组家庭测量血压及24小时平均收缩压、舒张压、白昼及夜间血压显著高于对照组.与对照组相比,高血压组AIx显著升高(24.4%±12.8%vs12.7%±18.3%,P=0.000),经年龄、性别调整后,二组间仍有显著性差异,提示高血压患者动脉顺应性下降、动脉硬化.将AIx作为因变量,年龄、身高、家庭测量血压及动态血压中24小时平均血压、白昼血压、夜间血压、血糖、血酯等作为自变量进行多元回归分析,AIx与年龄、家庭血压中的收缩压呈显著的正相关,与身高呈负相关,而家庭血压中的舒张压及动态血压未进入模型.结论家庭测量的收缩压可作为评价高血压患者动脉功能的重要指标.     

高血压病人动脉顺应性与家庭偶测血压及动态血压关系

目的　探讨原发性高血压病人家庭测量血压、动态血压与动脉顺应性的关系。方法　共入选 164例受试者 ,其中原发性高血压组 74例 [男 42例 ,女 3 2例 ,平均年龄 ( 4 7 0 5± 10 0 8)岁 ] ;对照组 90例 [男 41例 ,女 49例 ,平均年龄 ( 3 3 81±12 3 5 )岁 ]。对入选者间隔 1～ 3周进行二次家访 ,每次家访由经过专门训练的护士采用汞柱血压计连续测量受试者坐位、左上臂血压 5次 ,每人的家庭测量血压是二次家访、共 10个血压读数的平均值。同时采用SpaceLabs 90 2 0 7动态血压监测仪记录 2 4小时动态血压 ,有效数据应达到 80 %以上。动脉顺应性检查采用动脉脉搏波分析 (PWA)仪。反映大动脉硬化的参数为反射波增强指数 (AIx)。结果　高血压组家庭测量血压及 2 4小时平均收缩压、舒张压、白昼及夜间血压显著高于对照组。与对照组相比 ,高血压组AIx显著升高 ( 2 4 4%± 12 8%vs 12 7%± 18 3 % ,P =0 0 0 0 ) ,经年龄、性别调整后 ,二组间仍有显著性差异 ,提示高血压患者动脉顺应性下降、动脉硬化。将AIx作为因变量 ,年龄、身高、家庭测量血压及动态血压中 2 4小时平均血压、白昼血压、夜间血压、血糖、血酯等作为自变量进行多元回归分析 ,AIx与年龄、家庭血压中的收缩压呈显著的正相关 ,与身高呈负相关     

Efficacy and Safety of Angiotensin II Receptor Blockers in Elderly Patients With Mild to Moderate Hypertension

The role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertensive disease has long been recognized, and the interruption of this cascade with angiotensin-converting enzyme-I has been beneficial in the management of hypertension. Recently, a new class of drugs, the angiotensin receptor blockers, emerged, enlarging the antihypertensive armamentarium. Since elderly patients are more prone to adverse drug reactions, in this paper we review several trials, most of which were of short duration, on the efficacy and safety of angiotensin receptor blockers in the geriatric population with mild to moderate hypertension. These studies established that the drugs are well-tolerated, safe, and in most instances as efficacious as other classes of antihypertensive medications. Combination therapy with angiotensin receptor blockers and hydrochlorothiazide was additive, without any significant effect on the safety profile.     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的　应用动态血压监测 (ABPM )的方法评价贝尼地平治疗原发性高血压的降压疗效、谷 /峰比值及不良反应。方法　采用开放的方法 ,2 0例研究对象经 2周洗脱期 ,服用贝尼地平 4mg/d一次 ,2周末坐位舒张压 (SeDBP)≥ 90mmHg者加量至贝尼地平 8mg/d一次 ,继续服用 6周。于洗脱期末及治疗 8周末各行ABPM和实验室检查一次。结果　ABPM显示 8周末 2 4h、日间、夜间收缩压 (SBP/DBP)较洗脱期末分别下降 (9.4± 5 .4 / 6 .2± 4 .1)mmHg、(10 7± 6 .7/ 6 8± 3 8)mmHg、(6 9± 9 0 / 5 1± 7 7)mmHg。降压T/P值SBP为 5 8% ,DBP为 5 9%。无严重不良反应。 结论　贝尼地平 4～ 8mg/d一次为疗效确切的降压药物。     

妊娠期高血压疾病患者24h动态血压特征

目的探讨妊娠期高血压疾病患者24h动态血压特征。方法选择413例妊娠期高血压疾病患者（妊娠期高血压组）的动态血压,将其分成初产妇组（n=312）及经产妇组（n=101）．比较3组患者的昼夜均值、日间均值及夜间均值。分析妊娠期高血压组的血压特征分布规律,并与100例原发性高血压患者比较。结果妊娠期高血压疾病患者待产时的昼夜均值、日间均值及夜间均值（143．3±12．8／92．1±93mmHg、158．2±512／94．2±11．7mmHg、134．5±96／89．2±6．3mmHg）较出院后（123．2±9．8／74．5±6．7mmHg、133．6±11．3／78．1±7．2mmHg、118．4±7．8／68．9±5．7mmHg）的差异有统计学意义（P〈0．05）。初产妇组（142．4±11,1／91．4±8．4mmHg、149．8±138／89．2±9．7mmHg、132．6±8．9／87．4±6mmHg）与经产妇组（148．3±12．2／96．4±9．8mmHg、151．4±14．3／96．2±11．2mmHg、142．5±11．4／93．4±10．8mmHg）的差异无统计学意义（P〉0．05）。妊娠期高血压疾病患者的动态血压曲线以午间为高,呈“时段性”特点。结论妊娠期高血压疾病患者动态血压值与妊娠次数无关,而其动态特征呈“时段性”特征。     

新发青中年高血压病人动态血压水平及昼夜节律

目的探讨新发青年和中年高血压病人的动态血压水平及昼夜节律。方法对120例新发的青年和中年高血压病人行动态血压监测。120例高血压病人按年龄分为青年组(56例)和中年组(64例),观察各组病人动态血压水平及血压形态。结果新发青中年高血压病人中,血压水平属2级者占多数,需要联合用药;青年高血压病人舒张压水平高于中年病人(P0.05),青年高血压病人心率较中年病人快(P0.05);中年高血压病人脉压及脉压指数大于青年病人(P0.05),且非杓型血压形态更多见。结论对于新发的青中年高血压病人,除了诊室血压测量和家庭自测血压,24h动态血压监测可以全面了解病人血压水平及血压形态,为指导临床选择降压药物品种及服药时间提供依据。     

Relation of 24-h Ambulatory Blood Pressure With Plasma Potassium in Essential Hypertension

The established associations between blood pressure (BP) and electrolytes are mostly based on either dietary intake or urinary excretion data. We measured office BP, ambulatory BP (ABP) using the automated oscillometric ABPM-630 device, and plasma electrolytes in 82 essential hypertensive patients to examine the relation between BP and plasma electrolytes. Significant negative correlations were observed between plasma potassium concentration and 24-h systolic BP (r = −0.336) and diastolic BP (r = −0.298) in our patients. Plasma potassium concentration inversely correlated also with both daytime and nighttime systolic and diastolic BPs. There was no relation between office BP and plasma potassium concentration. These findings indicate that in essential hypertensives plasma potassium concentration is inversely related to ABP including daytime and nighttime BPs and suggest that potassium may be a factor determining the whole day BP in essential hypertension.     

甲磺酸多沙唑嗪治疗原发性高血压临床研究

目的 :评价甲磺酸多沙唑嗪片 (络欣平 )对轻、中度原发性高血压的疗效和近期安全性。　　方法 :对 344例患者进行随机、双盲和前瞻性对照研究 ,随机将患者分为口服甲磺酸多沙唑嗪组 (治疗组 96例 ) ,口服盐酸特拉唑嗪组 (对照组 97例 ) ;其他患者口服甲磺酸多沙唑嗪 (开放组 1 51例 ) ,所有患者均服药 4周。　　结果 :各组用药后血压均明显下降 ,有非常显著性差异 (P <0 0 1 ) ,治疗组、对照组和开放组降压总有效率分别为 91 6 6 %、 94 85%和 90 0 0 %。治疗组用药后血脂改变突出。各组肝肾功能和心电图检查均无明显异常改变。治疗组头晕、心悸等不良反应发生率为 1 4 5% ,与对照组无差异。　　结论 :国产甲磺酸多沙唑嗪片降压效果明显且稳定 ,对调节血脂有益 ,患者依从性好。     

动态血压监测二级筛选诊断高血压的价值

选择上海人民出版社医务室管辖的７７０名职工中的１０８例高血压（确诊１０２例，临界６例）为对象，观察停服降压药２周以上后的２４ｈ动态血压（ＡＢＰ）参数。在１０１例（检测率９３．５％）受检患者中，ＡＢＰ各项参数均正常者占１９．８％，随年龄增大而减少，男性１５．２％，女性３６．４％（Ｐ＜０．０５）；各项参数均升高者占２５．７％，随年龄增大而增加，男性３０．４％，女性９．１％（Ｐ＜０．１）。高血压患病率根据随测血压的ＷＨＯ标准为１４．０％，按照ＡＢＰ参数则为１１．２％。结果提示动态血压监测可以作为高血压诊断的二级筛选手段，有助于识别＂诊所高血压＂和高危患者。     

Exaggerated Blood Pressure Response to Exercise Is Not Associated With Masked Hypertension in Patients With High Normal Blood Pressure Levels

The association between exaggerated blood pressure (BP) response to exercise (ExBPR) and “masked hypertension” is unclear. Medical records of patients with high‐normal BP who were evaluated in the Chaim Sheba Screening Institute Ramat Gan, Israel, during the years 2002–2007 and referred for 24‐hour ambulatory BP monitoring (ABPM) and exercise test were reviewed. Data on exercise tests performed in the preceding 5 years were retrieved. Reproducible ExBPR was defined when it was recorded at least twice. BP levels on 24‐hour ABPM were compared between patients with a normal BP response and those with an ExBPR (systolic BP ≥200 mm Hg). Sixty‐nine normotensive patients with high normal BP levels were identified. ExBPR was recorded in 43 patients and was reproducible in 28. BP levels on 24‐hour ABPM were similar in patients with and without ExBPR. In patients with high‐normal BP levels, ExBPR is not associated with masked hypertension.     

比索洛尔／氢氯噻嗪复方片对血压晨峰的影响

目的 采用动态血压监测(ABPM)观察比索洛尔/氢氯噻嗪复方片对轻、中度原发性高血压患者服药后18～24 h血压和血压晨峰(MBPS)程度的影响.方法 选择90例轻、中度高血压患者[收缩压(SBP)<180mmHg,舒张压(DBP)95～109 mmHg],口服比索洛尔/氢氯噻嗪复方片2.5 rag/6.25 mg,4周后血压不达标者用比索洛尔/氢氯噻嗪复方片5.0 mg/6.25 mg继续治疗4周,应用ABPM评价治疗前后服血压和血压晨峰程度的变化.以起床后2 h内SBP增加≥23 mmHg,DBP>15 mmHg为晨峰阳性(MBPS)( )组,低于以上值为MBPS(一)组.结果 1)入选84例患者,比索洛尔/氢氯噻嗪复方片(2.5 mg/6.25 mg)治疗4周末,24 h SBP/DBP降低(10.8±1.7)/(8.6±0.8)mmHg,服药后18～24 h SBP/DBP降低(10.1±1.5)/(7.6±1.O)mmHg,治疗前后比较,差异有非常显著意义(P均d0.01).MBPS( )和(一)患者的服药后18～24 h SBP/DBP分别降低(11.1±2.5)/(8.9±1.8)mmHg(n=26)和(9.9±1.5)/(8.0±2.O)mmHg(n=58)(组间比较,P<0.05).MBPS( )患者的晨峰程度降低(14.1±2.7)/(10.5±2.5)mmHg(P<0.05),而MBPS(一)患者的晨峰程度未见明显降低,两组间有显著性差异(P相似文献