24-hour blood pressure monitoring in hypertension

It has been recognized for some time that blood pressure is highly variable over a 24-h period. A number of studies have demonstrated that the extent and severity of target-organ damage associated with hypertension can be correlated more closely with blood pressure values monitored continuously for 24 h than with individual values recorded sphygmomanometrically. A great deal of interest is focused on whether absolute values of diastolic or systolic blood pressure, values during the day or night, or the rate of change of blood pressure such as the rapid increase that occurs in the early morning are more or less important factors contributing to the mortality and morbidity associated with hypertension. Work from our own unit provides evidence of the importance of two features in the variability of blood pressure. Blood pressure decreases during the night, but remains higher in hypertensive patients than in normotensive subjects. The mean nighttime blood pressure was shown to correlate with hypertension-related target-organ damage almost as closely as the mean daytime blood pressure. Using 24-h blood pressure monitoring, we have shown that the higher the mean 24-h blood pressure, the greater the extent and severity of target-organ involvement. In addition, for patients with comparable mean 24-h blood pressure values, larger degrees of blood pressure variability throughout the monitoring period were associated with more target-organ damage. Taking the available evidence into account, it is probably important that treatments used for hypertension should provide control of blood pressure for a full 24-h period confirmed by ambulatory blood pressure monitoring.     

Effect of amlodipine on 24-hour ambulatory blood pressure in hypertensive patients

Sixteen hypertensive patients (diastolic blood pressure of 95-114 mm Hg) were randomized to receive 5 mg of amlodipine daily or placebo, double blind, for 4 weeks. Antihypertensive efficacy was assessed using ambulatory blood pressure monitoring at baseline and following double-blind therapy in conjunction with sphygmomanometric measurement at 2-week intervals. Laboratory tests, ECG, and adverse effects were recorded to assess tolerability. Amlodipine treatment significantly reduced ambulatory blood pressure without altering the normal circadian variation throughout the monitoring period. Supine and standing blood pressure were significantly reduced by amlodipine 24 h postdose. Amlodipine was well tolerated and was not associated with reflex tachycardia.     

Sustained antihypertensive activity of diltiazem SR: double-blind, placebo-controlled study with 24-hour ambulatory blood pressure monitoring.

A new polymeric matrix technology provides a sustained-release formulation of diltiazem hydrochloride (diltiazem SR) suitable for once-daily therapy. The efficacy and safety of diltiazem SR were evaluated in a multicenter, randomized, double-blind, placebo-controlled, parallel-group study. After a single-blind, placebo lead-in period, 275 patients with mild to moderate essential hypertension were assigned to receive placebo or diltiazem SR 120, 240, 360, or 480 mg once daily for 4 weeks. The efficacy evaluation was based on office and 24-hour ambulatory blood pressure monitoring. Twenty-four hours after the last dose in the 4-week, double-blind treatment period, the mean reduction from baseline in supine diastolic blood pressure ranged from 5.1 to 10.6 mm Hg in the diltiazem SR 120- to 480-mg groups, resulting in a significant linear trend across all treatments (P less than .001). Reductions in systolic blood pressure were similar. Ambulatory blood pressure monitoring, performed in 138 patients, confirmed the dose-response relationship and showed consistent antihypertensive activity throughout the 24-hour dosing interval. The percentage of patients reporting adverse events was similar in the placebo- and active-treated groups. The results of this study indicate that diltiazem SR is well tolerated, lowers blood pressure in a dose-related manner, and provides sustained activity throughout the 24-hour dosing interval.     

Smooth blood pressure control obtained with extended-release felodipine in elderly patients with hypertension: evaluation by 24-hour ambulatory blood pressure monitoring

OBJECTIVE: To assess, by smoothness index (SI), distribution of the antihypertensive effect of extended-release (ER) felodipine over 24 hours in elderly patients with hypertension. METHODS: After a 4-week washout phase, 35 elderly patients (mean age 69 +/- 4 years) with mild-to-moderate hypertension received 2 weeks' treatment with ER felodipine 5mg once daily. The dosage of ER felodipine was doubled to 10 mg/day and given for a further 2 weeks in non-responders (sitting clinic blood pressure > 140/90mm Hg). The study had an open-label design with no placebo control. After each period, clinic and ambulatory blood pressures were measured. Trough-to-peak (T/P) ratio was computed by dividing the blood pressure (BP) change at trough (22 to 24 hours after drug intake) by the change at peak (2 adjacent hours with a maximal BP reduction between the second and eighth hour after drug intake). SI was calculated as the ratio between the average of the 24, hourly, treatment-induced BP changes and its standard deviation. RESULTS: After the initial 2-week treatment period, clinic and 24-hour ambulatory BP values were higher in non-responders (145 +/- 11/87 +/- 8 and 135 +/- 17/80 +/- 6mm Hg, respectively) than in responders (133 +/- 6/81 +/- 3 and 130 +/- 9/77 +/- 7mm Hg). In non-responders, clinic and 24-hour BP values were lowered after a further 2 weeks of treatment with ER felodipine 10 mg/day (128 +/- 11/78 +/- 6 and 128 +/- 12/75 +/- 5mm Hg). SI was high in responders (0.8 +/- 0.8/0.7 +/- 0.7 for systolic/diastolic BP) and low in non-responders (0.5 +/- 0.6/0.3 +/- 0.6) during the first 2-week treatment period. It increased in non-responders after an additional 2 weeks of treatment with ER felodipine 10 mg/day (1.0 +/- 0.8/0.7 +/- 0.6). Median T/P ratios were 0.73 and 0.61 (systolic BP and diastolic BP) in responders and 0.41 and 0.61 in non-responders after 2 weeks of treatment. At variance with SI, T/P ratios did not increase in non-responders after doubling the dosage of ER felodipine (0.34 and 0.18). ER felodipine did not increase 24-hour heart rate. A total of nine adverse events were recorded in six patients (17%), but no patients withdrew from the study. CONCLUSION: ER felodipine 5 to 10 mg/day smoothly and safely reduces 24-hour ambulatory BP in elderly patients with hypertension.     

24-hour blood pressure control with the once-daily calcium antagonist amlodipine

The efficacy and toleration of once-daily amlodipine (5-10 mg) was studied in 11 patients with mild to moderate hypertension. Continuous intra-arterial blood pressure monitoring was used to study the effects of amlodipine over a 24-h period. Following a 2-week placebo run-in period, amlodipine was given initially as a single-blind 5-mg dose for 2 weeks and increased to 10 mg if required to control blood pressure for a further 4 weeks. Twenty-four-hour intra-arterial blood pressure recordings made after 6 weeks of treatment with amlodipine revealed that amlodipine effectively reduced blood pressure throughout the whole 24-h period without altering the normal circadian pattern. The mean daytime blood pressure was reduced from 165/103 to 147/89 mm Hg (p < 0.05) and the mean nighttime blood pressure was reduced from 137/79 to 121/69 mm Hg (p < 0.05). There was no significant change in heart rate. The mean supine blood pressure measured sphygmomanometrically was reduced from 169/103 mm Hg after placebo to 153/98 mm Hg after 2 weeks of treatment and to 145/92 mm Hg at the end of the study. The results of isometric and dynamic exercise testing showed that amlodipine decreased blood pressure, with no postural decrease on tilting and no change in the proportional increase in blood pressure at peak exercise. Amlodipine was well tolerated although one patient developed ankle edema that would have required discontinuation had she not already completed the study. This study has shown that amlodipine effectively reduced blood pressure for 24 h after once-daily dosing and was well tolerated.     

Noninvasive 24-hour ambulatory blood pressure monitoring: overview of technology and clinical applications

During the last 25 years, 24-hour noninvasive ambulatory blood pressure monitoring (ABPM) has evolved from a research tool of limited clinical use into an important tool for stratifying cardiovascular risk and guiding therapeutic decisions. Until recently, clinical use of ABPM focused on identifying patients with white-coat hypertension, but accumulated evidence now points to greater prognostic significance of ABPM in determining risk for target-organ damage compared with that of office blood pressure measurements. Clinicians involved in the care of patients with hypertension should familiarize themselves with the role of this technology and how to use it in an appropriate and cost-effective manner.     

A comparison of the efficacy of captopril and enalapril given once daily for the treatment of hypertension: a study using 24-hour ambulatory blood pressure monitoring

Sixteen patients who had essential hypertension were stabilized on either captopril or enalapril monotherapy and had 24-hour blood pressure profiles monitored by using one of two automatic, non-invasive ambulatory systems: Spacelabs 5300 (Squibb, Princeton, NJ) or PAR Physioport II (Kardiotec, Mannheim). In four subjects (group 1), ambulatory pressures were repeated 4 to 6 weeks later using the same equipment and the same drug. In four subjects (group 2), the drug was changed (dose ratio: captopril:enalapril, 5:1) after the first measurement, but the monitoring equipment was not changed. In four subjects (group 3), the drug was constant, but the equipment was changed for the second measurement of ambulatory pressure. In four subjects (group 4), both drug and equipment were reversed after the first measurement. The results showed that both drugs (given once daily) controlled blood pressure during the 24-hour period, with no clinically significant difference between them.     

Comparison of 24-hour blood pressure profiles in patients with hypertension who were switched from amlodipine to nisoldipine.

STUDY OBJECTIVE: To compare 24-hour blood pressure control and adverse effects in patients with essential hypertension who were switched from amlodipine to nisoldipine. DESIGN: Open-label, one-way crossover study. SETTING: Cardiac clinic and patients' homes. PATIENTS: Twenty-five patients with stage I or II essential hypertension stabilized with amlodipine for at least 3 months, of whom 21 patients completed the study. INTERVENTION: All patients underwent 24-hour ambulatory blood pressure monitoring while receiving amlodipine 5 or 10 mg/day. Patients then were switched to nisoldipine 10 mg/day (> or = 65 yrs old) or 20 mg/day (< 65 yrs old) and returned to the clinic at 2-week intervals to assess cuff blood pressure, heart rate, adverse effects, and compliance. No adverse effects were experienced in 15 of the 25 patients. Lower extremity edema was the most commonly reported adverse effect (four patients). Two patients discontinued treatment because of pulmonary edema in one and chest pain in the other. Two patients were lost to follow-up. After a mean of 10.6 weeks, repeat 24-hour ambulatory monitoring was performed to evaluate blood pressure control with nisoldipine. Systolic and diastolic ambulatory results for daytime, nighttime, and total 24 hours were calculated. For amlodipine versus nisoldipine, no significant differences existed in any of the blood pressure parameters (p>0.05) in the 21 patients who completed the study, except for 24-hour diastolic pressure (p<0.05); however, this latter difference was only 2 mm Hg (nisoldipine 77 mm Hg, amlodipine 75 mm Hg). CONCLUSION: Both amlodipine and nisoldipine have similar 24-hour ambulatory blood pressure profiles. The frequency of lower extremity edema was no different after the switch to nisoldipine than when the patients were taking amlodipine.     

24小时动态血压监测托拉塞米注射液对老年中重度心力衰竭患者的疗效

目的探讨托拉塞米注射液对老年中重度心力衰竭患者的疗效。方法对我院收治的80例重度充血性心力衰竭患者,随机分实验组和对照组,各40例,实验组给予托拉塞米组治疗,对照组给予呋塞米治疗,同时给予24小时动态血压检测,7天后观察疗效。结果实验组治疗后平均24小时尿量、血压SBP、DBP以及体重下降值、浮肿消退显效率、BNP、K＋和Na＋水平、血气分析、心功能改善有效率等均明显优于对照组（P〈0．05）。结论短期应用托拉塞米疗效确切,可显著改善患者的临床症状,改善患者心功能     

动态血压监测氨氯地平控制血压及其晨峰的疗效

目的：采用动态血压监测（ABPM）观察氨氯地平（络活喜）对1、2级原发性高血压患者服药后血压和血压晨峰（MBPS）程度的影响。方法：对入选的150例1、2级高血压患者口服氨氯地平,服用前及8周后应用ABPM评价血压和血压晨峰程度的变化。结果：150例高血压患者治疗8周后,无论收缩压还是舒张压与治疗前比较,均明显下降（P〈0.05）;MBPS（＋）的患者减少,MBPS（-）的患者增多,治疗前后频数比较,差异有显著统计学意义（P〈0.01）。结论：苯磺酸氨氯地平不仅能有效控制24h血压,而且还能降低血压晨峰程度。     

24-hour control of blood pressure by once daily doxazosin: a multicentre double-blind comparison with placebo

Summary The antihypertensive efficacy of the new, once daily, alpha₁-adrenoceptor inhibitor, doxazosin, was compared with placebo in 40 patients with mild to moderate hypertension. Following a dose titration the mean final daily doxazosin dose in 20 patients was 13.1 mg.Through-the-day blood pressure control was assessed by frequent measurements during 24 h hospitalisation in the 9 th week of double-blind treatment compared with similar measurements made during a 2 week single-blind placebo run-in.Mean reductions in standing and supine systolic and diastolic blood pressure during doxazosin treatment were statistically significantly greater than during placebo treatment at most hourly time points during the 24 h post-dose period. Twenty-four post-dose the mean falls in standing and supine diastolic blood pressure during doxazosin treatment were statistically significant when compared with placebo. Adverse effects during doxazosin treatment were generally minor and were tolerated or disappeared with continued therapy. No patients were withdrawn from the study due to adverse effects.We conclude that once daily doxazosin provides smooth and effective blood pressure control throughout a 24 h post-dose period.     

动态血压监测评价苯磺酸氨氯地平和氯沙坦对老年单纯收缩期高血压的降压疗效

目的：应用动态血压监测评价苯磺酸氨氯地平和氯沙坦对老年单纯收缩期高血压的降压疗效及谷峰比值（T／P）。方法：60例老年单纯收缩期高血压患者随机分为2组，即氨氯地平组和氯沙坦组，各30例，分别服药治疗8周，于治疗前后测定动态血压、诊室随测血压、心率、生化指标。结果：治疗8周末，2组的诊室随测血压和24h、白昼及夜间平均收缩压、收缩压负荷值均显著降低（P〈0．05），而心率则无明显变化。8周末，2组的降压总有效率分别为90％和93％。2组降压幅度比较差异无显著性（P〉0．05）。降压T/P比值均大于50％，2组患者出现的不良反应均轻微。结论：氨氯地平与氯沙坦均能平稳、有效、安全地降低老年单纯收缩期高血压，不良反应少，可作为老年单纯收缩期高血压的一线用药。     

原发性高血压患者213例动态血压监测分析

目的 分析原发性高血压患者24 h动态血压监测（ABPM）变化规律及临床意义。方法 2011年1月至2013年9月对213例原发性高血压患者进行24 h ABPM,观察其24 h平均收缩压（24 h MSP）、24 h平均舒张压（24 h MDP）、白昼平均收缩压（dMSP）、白昼平均舒张压（dMDP）、夜间平均收缩压（nMSP）、夜间平均舒张压（nMDP）、夜间血压下降率。结果 213例原发性高血压患者中100例为杓型血压,78例为非杓型血压,35例为反杓型血压。随年龄增长反杓型血压发生率明显升高,其中老年组（≥60岁）患者反杓型血压发生率较中青年组（＜60岁）高,而老年组患者杓型血压发生率较中青年组患者低,差异均有统计学意义（P＜0.05）。不同年龄段女性患者反杓型血压发生率较男性高,但二者比较,差异均无统计学意义（P＞0.05）。结论 原发性高血压患者平时血压波动情况通过24 h ABPM能更加真实地反映出来。随着年龄的增长,原发性高血压患者24 h动态血压昼夜节律异常发生率不断增高,提示增龄可明确影响到原发性高血压患者的血压节律变化,应尽早进行干预治疗。     

高血压病患者24小时平均脉压与靶器官损害的关系

目的探讨高血压病患者24小时平均脉压（ABPP）与靶器官损害的关系。方法把246例高血压病患者根据动态血压检测的结果分为ABPP≥60mmHg和ABPP〈60mmHg两组,将两组的超声心动图、心电图、血肌酐、颅脑CT资料进行对比分析。结果与ABPP〈60mmHg组比较,ABPP≥60mmHg组心肌肥厚、心脏收缩和／或舒张功能减退、心电图异常、肾功能损害、脑血管意外病例明显增多。结论高血压病患者中,随着脉压增大,增加了对心脏、大脑、肾脏等靶器官的损害,进而造成心脑血管疾病发病率增高,因此在高血压治疗中积极控制脉压将有效减轻靶器官损害。     

Antihypertensive effect of lisinopril assessed by 24-hour ambulatory monitoring: a double-blind, placebo-controlled, cross-over study.

The antihypertensive effect of the angiotensin-converting enzyme (ACE) inhibitor lisinopril administered in a single dose of 20 mg was evaluated by ambulatory blood pressure monitoring (ABPM) in a double-blind, placebo-controlled, cross-over study. Twenty-four patients (21 men and 3 women, mean age 52 +/- 6 years) with mild to moderate hypertension were included in the study and randomly assigned to two consecutive treatments with lisinopril 20 mg and placebo, each administered for 4 weeks. On the last day of each treatment, BP was assessed by noninvasive 24-h ABPM. BP was significantly lower after lisinopril than after placebo in a 24-h period (mean 24-h systolic BP (SBP) with lisinopril 120 +/- 7 mm Hg and with placebo 135 +/- 9 mm Hg; mean day SBP with lisinopril 125 +/- 3 mm Hg and with placebo 142 +/- 5 mm Hg; mean night SBP with lisinopril 112 +/- 4 mm Hg and with placebo 124 +/- 6 mm Hg; mean 24-h diastolic BP (DBP) with lisinopril 76 +/- 6 mm Hg, and with placebo 87 +/- 8 mm Hg; mean day DBP with lisinopril 80 +/- 3 mm Hg and with placebo 93 +/- 4 mm Hg; mean night DBP with lisinopril 69 +/- 2 mm Hg and with placebo 79 +/- 5 mm Hg, p less than 0.001). Mean 24-h, mean day, and mean night heart rate (HR) did not differ significantly between placebo and lisinopril treatments. Repeated-measures analysis of variance (ANOVA) showed a significant influence on SBP (p less than 0.001) and DBP (p less than 0.001) throughout the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Olmesartan medoxomil combined with hydrochlorothiazide improves 24-hour blood pressure control in moderate-to-severe hypertension

Abstract

Background:

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has been shown to be more reliable than conventional measurements for hypertension assessment and the associated increased risk of cardiovascular events. Olmesartan/hydrochlorothiazide combination therapy has demonstrated increased blood pressure lowering over 24 hours compared with the component monotherapies. This prespecified pooled analysis of data from two trials investigated the effects of olmesartan/hydrochlorothiazide combination therapy and olmesartan monotherapy on 24-hour blood pressure control in patients with moderate-to-severe hypertension.