The nifedipine gastrointestinal therapeutic system (GITS) is a recently developed controlled-release formulation for once-a-day dosing. We evaluated the influence of morning versus evening administration of the drug in a randomized double-blind cross-over study including 15 essential hypertensives. Five patients had to be excluded from blood pressure analysis because of noncompliance (three cases) or intolerable side effects (two cases). To assess the exact duration of the antihypertensive efficacy noninvasive automatic ambulatory blood pressure monitoring was performed. After a placebo period patients were given 30 mg nifedipine GITS either at 1000 or 2200 hours. Twenty-four-hours systolic and diastolic blood pressure profiles documented a sustained antihypertensive effect of both nifedipine regimens throughout the whole period without affecting the circadian rhythm. Statistical analysis revealed no significant difference between morning and evening administration. Two patients stopped their medication because of intolerable side effects (fatigue and muscle cramps, respectively). Two more cases suffered from mild reversible headache which provoked no discontinuation of the drug. In conclusion our results document a sustained antihypertensive efficacy of 30 mg nifedipine GITS in patients with moderate essential hypertension. Time of administration has no impact on day- and nighttime blood pressure control.
Increasingly, patients measure and record their home blood pressure. However, the accuracy with which they report their readings to their physicians is largely unknown. The authors assessed the accuracy and quality of self-reported home blood pressure values in an ambulatory managed care population. Forty-eight hypertensive outpatients were randomly allocated to either receive information about the storage capabilities of a home blood pressure measuring device or not to receive such information. All patients were asked to record the measurement results in a logbook twice daily over a 7-day period. The main outcome measure was the difference in the number of fictional or manipulated reports per group and the difference in missing values. The combined parameter manipulated or fictional registrations occurred significantly less frequently in the informed group than in the noninformed group. (10/728 vs. 29/616; relative risk, 0.292; 95% confidence interval, 0.15-0.57; Pearson chi squared=13.15; p<0.0001). Informed patients had fewer missing registrations than the noninformed (13/728 vs. 41/616 measurements; relative risk, 0.27; 95% confidence interval, 0.15-0.47; Pearson chi squared =20.5; p<0.0001). The mean of the fictional data did not differ systematically from the mean of the correctly reported individual blood pressure values. There was no trend to over- or underestimate blood pressure values in the noninformed group. With this study design, it was possible to identify manipulation of home blood pressure values for the first time. Accuracy and interpretation of home blood pressure measurement may be increased by using devices with a memory function.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.