Plana, J.1; Poblet, T.2; Roma, J.3; Sobrino, J.2; Pou, G.4; Vila, J.5; Felipé, A.6; Minguez, A.7; Modol, J.8; Coca, A.9 Author Information

: Wednesday, June 16, 2004: POSTER SESSIONS: Poster Session 43: BP Measurements and Hemodynamics

Sobrino-Martinez, Javier; Vila, J.; Modol, J.; Pelegri, A; Pou, G.; Minguez, A; Domenech, M.; Adrian, M.; Felip, A; Plana, J. Author Information

The once-daily fixed combination of losartan 100 mg/hydrochlorothiazide 25 mg was evaluated for safety and efficacy in a multicenter open study by using 24-h ambulatory blood pressure monitoring in untreated patients with moderate-to-severe essential hypertension or patients with uncontrolled hypertension despite treatment with monotherapy or low-dose combination. After a 2-week washout period, 41 patients (22 men, 19 women) aged 34-74 years, showing a mean daytime blood pressure > 135/85 mm Hg, were treated with losartan 100 mg/hydrochlorothiazide 25 for 8 weeks. Ambulatory blood pressure was monitored at the end of the washout period and during the last week of treatment. A significant reduction in the average values of clinic blood pressure (from 169.9 +/- 13.5 mm Hg to 139.5 +/- 15.6 mm Hg, p < 0.001 for systolic blood pressure [SBP]; and from 102.2 +/- 7.1 mm Hg to 85.1 +/- 9.5 mm Hg, p < 0.001 for diastolic blood pressure [DBP]) was observed after treatment in the whole group of 41 patients. Likewise, average values of both 24-h SBP and 24-h DBP were significantly reduced (from 145.7 +/- 13.1 mm Hg to 128.3 +/- 14.6 mm Hg, p < 0.001 for 24-h SBP; and from 90.3 +/- 7.3 mm Hg to 79.2 +/- 8.6 mm Hg, p < 0.001 for 24-h DBP). The average lowering at peak was 20.2 +/- 11.8 mm Hg for 24-h SBP and 12.1 +/- 7.4 mm Hg for 24-h DBP, whereas the lowering at trough was 17.8 +/- 12.0 mm Hg and 10.4 +/- 8.1 mm Hg, respectively. The trough-to-peak ratio (T/P) was 0.88 for SBP and 0.86 for DBP, and the smoothness index was 7.36 for SBP and 6.37 for DBP. The response rate was 87.8% (blood pressure lowering > 5 mm Hg of either 24-h SBP or 24-h DBP average values). Among responders, T/P ratio was 0.89 for SBP and 0.87 for DBP, and the smoothness index was 8.09 for SBP and 7.15 for DBP. No side effects or changes in metabolic parameters were observed. The fixed combination of losartan 100 mg/hydrochlorothiazide 25 was very effective and well tolerated.

AustraLiaArthritis is relatively common in older hypertensive patients and they require non steroidal anti-inflammatory drags (NSAID).This may lead to loss of hypertensive control due in part to sodium retention.Dihydropyridine calcium channel blocking drugs' effects are relatively independent of sodium status and NSAID may not have this adverse effect in people treated with amlodipine.Twentythree patients (IgM, 5F) age 60-80 (mean 69y) with essential hypertension well controlled on amledipine (5 or 10 mg/d) completed a double blind, crossover study comparing the effect of placebo or indomcthacin (50 mg twice daily) over a 3 week period on BP.BP was measured at the clinic (24 hours post dose) and by ambulatory BP monitoring for 27 hours.At the end of the double blind placebo period clinic BP was 153 ± 3/81 ± 1.5 mmHg and at the end of the indomethacin period 156 ± 3/82 ± 19 mmHg (n = 23, p >0.2).The mean 24 hour BP on placebo was 141 ± 2/76.8 ± 1.4 and on indomethacin was 142 ±2/77.2± 1.2 (n = 23, p >0.4).There were no differences in daytime, night time or early morning BP (see Table).The power to detect a difference of 2 mmHg or more was 95% Blood Pressurre mmHg Placebo lndomethacin Sys Diast Sys Diast p 24h mean 141±2 76.8±1.4 142±2 77.2±1.2 >0.4 day mean 143±2 78.4_+1.4145±2 79.3±1.3 >0.3 night mean 128±3 67.5±1.8 130±3 67.6±1.2 >0.4 morning mean 149±3 82.2_+1.7 149±3 81.5±1.7 >0.8 Weight rose by 0.64 ± 0.28 Kg (p < 0.05).Plasma renin and aldosterone were not altered.lndomethaein can be given to people controlled on amlodipine without causing a rise in BP and is a preferred treatment for hypertensive patients with associated arthritis.

Once-daily diltiazem extended-release 240 mg (Lacerol-HTA Retard) was evaluated for safety, efficacy, and trough-to-peak ratio in a multicenter open study by using 24-h blood pressure (BP) monitoring in mild-to-moderate essential hypertension. After a 4-week washout period, 30 patients (17 men, 13 women) aged 25-76 years, showing a mean daytime diastolic BP (DBP) >90 mm Hg, were treated with diltiazem-ER, 240 mg, given once daily for 8 weeks. Ambulatory BP monitoring was obtained at the end of a 4-week placebo run-in period and during the last week of treatment. A significant reduction of the mean values of clinical BP [161.6 +/- 16.2 to 151.2 +/- 15.6 mm Hg; p < 0.01 for systolic BP (SBP); and 101.1 +/- 4.8 to 93.3 +/- 9.2 mm Hg; p < 0.001 for DBP] was observed at the end of treatment in the group of 30 patients, with no significant changes in heart rate (77.1 +/- 9.9 to 73.1 +/- 11.1 beats/min; p = NS). Likewise, mean values of 24-h SBP, DBP, SBP-load, and DBP-load were significantly reduced. In the group of 21 responders, the average reduction at peak was -18.6 +/- 12.9 mm Hg for SBP and -14.7 +/- 9.5 mm Hg for DBP. The residual effect at trough was -12.2 +/- 14.7 and -8.1 +/- 10 mm Hg, respectively. The trough-to-peak ratio was estimated as 0.66 for SBP and 0.55 for DBP. Long-term variability expressed as the mean standard deviation of BP for the 24-h period was reduced in responders (16.2 +/- 4.3 to 14.6 +/- 2.7 mm Hg for SBP; p = 0.0395; and 12.1 +/- 2.7 to 10.7 +/- 2.5 mm Hg for DBP; p = 0.0019), although no changes were observed in the variation coefficient (10.58-10.57% for SBP and 12.88-12.87% for DBP). We conclude that once-daily diltiazem-ER, 240 mg, was effective and well tolerated. Blood pressure was controlled over the entire period of 24 h, preserving the circadian profile and reducing long-term variability in responders. The significant reduction of both BP values and long-term variability may have implications involving protection from end-organ damage in essential hypertension.

The aim of the study was to compare the antihypertensive efficacy of once-daily lisinopril vs enalapril both during normal daily activity and sleep, in mild-to-moderate essential hypertension. After a 4-week wash-out period, 34 patients (17 M, 17 F) aged 22 to 67 years were randomized in a multicenter, open, parallel fashion: 17 received lisinopril (10-20 mg) and 17 enalapril (10-20 mg) for a 12-week period. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed using an oscillometric non-invasive automated device at both the end of the 4-week drug-free baseline period and during the last week of treatment. With no differences in initial blood pressure (BP) between groups, both drugs significantly reduced office and ABPM values. Lisinopril tended to reduce BP in a greater extension than enalapril, but only the reduction of office systolic BP (SBP) (p = 0.0062), 24-h SBP load (P = 0.0182) and night time SBP load (P = 0.0316) reached statistical significance. We conclude that, in spite of a more prominent reduction of SBP by lisinopril, both drugs have a similar efficacy in reducing BP, assessed by both office and ABPM measurements.