24-hour blood pressure control with ramipril: comparison of once-daily morning and evening administration

Myburgh, D. P.; Verho, M; Botes, Joan H.; Erasmus, T.; Luus, H. G.

doi:10.1016/0011-393x(95)85074-0

Cited by 40 publications

(17 citation statements)

References 12 publications

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“…Several crossover studies (morning vs evening dosing) have been published for both ACE inhibitors 82,89,[126][127][128] and AT 1 -receptor blockers. [129][130][131] They demonstrated that in contrast to morning dosing, evening dosing of ACE inhibitors such as benazepril, enalapril, and perindopril resulted in a more pronounced nightly drop.…”

Section: Ace Inhibitors and At 1 -Receptor Blockersmentioning

confidence: 99%

The importance of biological rhythms in drug treatment of hypertension and sex-dependent modifications

Lemmer

2012

CPT

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Abstract:The cardiovascular system is highly organized in time. Blood pressure, heart rate, peripheral resistance, pressure, and vasodilating hormones display pronounced circadian variations. New data presented here demonstrate also sex-dependent differences in vasodilating hormones, with higher NO χ excretion in females than males and a steeper early morning rise in norepinephrine in males, whereas the 24-hour blood pressure and heart-rate profiles were not different. Various antihypertensive drugs were investigated in crossover studies -morning versus evening dosing -in hypertensive patients; however, consistent data were only described for angiotensin-converting-enzyme (ACE) inhibitors, calcium channel blockers, and angiotensin II type 1 (AT 1 ) receptor blockers. Whereas in dippers ACE inhibitors had a superdipping effect when dosed at night, no difference in the blood pressure lowering effect or on the 24-hour blood pressure profile was found with calcium channel blockers after morning and evening dosing. In nondippers, the calcium channel blockers isradipine and amlodipine transformed nondippers into dippers, similar after evening dosing. The effects of AT 1 -receptor blockers are similar to those of ACE inhibitors. Also, diuretics are able to normalize non dipping behavior. Moreover, a circadian phase dependency in their pharmacokinetics has been demonstrated for various cardiovascular-active drugs, such as beta blockers, calcium channel blockers, oral nitrates, and ACE inhibitors, modified by the galenic formulation. There is evidence that in hypertensive dippers, antihypertensive drugs should be given during early morning hours, whereas in non dippers it can be necessary to add an evening dose or even to apply a single evening dose in order not only to reduce high blood pressure, but also to normalize a disturbed non dipping 24-hour blood pressure profile.

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Section: Ace Inhibitors and At 1 -Receptor Blockersmentioning

confidence: 99%

The importance of biological rhythms in drug treatment of hypertension and sex-dependent modifications

Lemmer

2012

CPT

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“…Ramipril has the advantage of being a long-acting substance compared with other ACE inhibitors, with an effective half-life of 13-17 h in adults [13]. It may therefore be given once daily and has few side effects [14,15]. It has a high affinity to ACE and shows a tight binding to the enzyme in the circulation and in tissues [16,17].…”

Section: Introductionmentioning

confidence: 99%

Effect of ramipril on ambulatory blood pressure and albuminuria in renal hypertension

Soergel

Verho²,

Wühl

et al. 2000

Pediatric Nephrology

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Inhibition of the angiotensin-converting enzyme (ACE) exerts a renoprotective effect in adult patients with chronic kidney disease. We evaluated prospectively changes in blood pressure (BP), protein excretion and renal function after administration of the long-acting ACE inhibitor ramipril as monotherapy during 6 months in 14 moderately hypertensive children aged 5-18 years with various nephropathies. Four patients initially had a decreased glomerular filtration rate (GFR below 60 ml/min/1.73 m2). BP was evaluated by ambulatory 24-h monitoring. After 2 weeks of treatment by oral ramipril (1.5 mg/m2 once daily), mean values of systolic and diastolic 24-h ambulatory BP fell by more than 5 mmHg in nine patients. In eight patients the dose was doubled. At the end of the study systolic BP was below the 95th percentile in 9 and diastolic BP in 13 patients. The initially reduced nocturnal dip increased significantly. Of 11 patients with an increased albumin excretion (median 1.3 g/g creatinine), 6 responded to ramipril by a median reduction of 78% (range 24-83%), whilst in 5 albuminuria increased (median +19%). GFR was well preserved and no other adverse effects from the drug were noted. The study demonstrates that ramipril is an efficacious antihypertensive agent in children with renal hypertension. It is well tolerated, even in mild renal insufficiency. In addition, the drug has a persistent antiproteinuric action in about half of the patients contributing to conserve renal function.

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“…6 Despite the great number of published evaluations of antihypertensive drug efficacy, rarely has the time of day of drug administration been a specific focus of investigation. 6 Previous studies have demonstrated, for instance, a different effect of the angiotensin-converting enzyme inhibitors benazepril, 9 enalapril, 10 quinapril, 11 ramipril, 12 and perindopril 13 when dosed in the morning versus the evening. In the HOPE (Heart Outcomes Prevention Evaluation) substudy on ambulatory BP monitoring (ABPM), subjects treated with ramipril at bedtime showed a marked BP reduction particularly during nighttime sleep, 14 which was associated with a reduction in the prevalence of nondippers (patients with Ͻ10% decline in the nocturnal relative to the diurnal BP mean 15 ).…”

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Administration Time–Dependent Effects of Valsartan on Ambulatory Blood Pressure in Hypertensive Subjects

et al. 2003

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Abstract-This study investigated the administration time-dependent antihypertensive efficacy of valsartan, an angiotensin II receptor blocker. We studied 90 subjects (30 men and 60 women), 49.0Ϯ14.3 (meanϮSD) years of age with stage 1 to 2 essential hypertension; they were randomly assigned to receive valsartan (160 mg/d) as a monotherapy either on awakening or at bedtime. Blood pressure was measured by ambulatory monitoring every 20 minutes during the day and every 30 minutes at night for 48 consecutive hours before and after 3 months of treatment. Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately calculate the diurnal and nocturnal means of blood pressure on a per-subject basis. The highly significant blood pressure reduction after 3 months of treatment with valsartan (PϽ0.001) was similar for both treatment times (17.0 and 11.3 mm Hg reduction in the 24-hour mean of systolic and diastolic blood pressure with morning administration and 14.6 and 11.4 mm Hg reduction with bedtime administration; PϾ0.174 for treatment time effect). Valsartan administration at bedtime as opposed to on wakening resulted in a highly significant average increase by 6% (PϽ0.001) in the diurnal-nocturnal ratio of blood pressure; this corresponded to a 73% relative reduction in the number of nondipper patients. The findings confirm that valsartan efficiently reduces blood pressure throughout the entire 24 hours, independent of treatment time. They also suggest that time of treatment can be chosen according to the dipper status of a patient to optimize the effect of antihypertensive therapy, an issue that deserves further investigation. Valsartan is an orally active, specific and selective ARB. 2 After a single oral morning dose, the onset of its BP-lowering action is within 2 hours, with peak effect occurring within 4 to 6 hours. Morning once-a-day dosing ranging from 80 to 320 mg/d results in BP reduction throughout the entire 24 hours. 3,4 The trough-to-peak ratio (T:P; the average BP reduction during the last 2 hours of the dosing interval compared with the average of the maximal reduction in BP over 2 consecutive hours 5 ) has been demonstrated to be Ͼ75%, 4 confirming that a single morning dose of valsartan provides effective BP control throughout the day without alteration of the circadian pattern of BP variation. 3 This circadian variation in BP represents, on the one hand, the influence of internal factors such as ethnicity, gender, autonomic nervous system tone, vasoactive hormones, and hematologic and renal variables. 6 BP is also affected by a variety of external factors, including ambient temperature/ humidity, physical activity, emotional state, alcohol or caffeine consumption, meal composition, and sleep/wake routine. 7,8 Because the main steps in the mechanisms regulating BP are circadian-stage dependent, 7 it is not surprising that antihypertensive medications might display a circadian time dependency in their pharmacokinetics and effects. 6 Despite the great number of publishe...

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24-hour blood pressure control with ramipril: comparison of once-daily morning and evening administration

Cited by 40 publications

References 12 publications

The importance of biological rhythms in drug treatment of hypertension and sex-dependent modifications

The importance of biological rhythms in drug treatment of hypertension and sex-dependent modifications

Effect of ramipril on ambulatory blood pressure and albuminuria in renal hypertension

Administration Time–Dependent Effects of Valsartan on Ambulatory Blood Pressure in Hypertensive Subjects

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