Assessment of Antihypertensive Effect by Blood Pressure Monitoring: Applications to Bisoprolol and Lisinopril in a Double-Blind Study

Abstract

The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure (BP) level. After a 15-day placebo run-in period, 105 patients with moderate essential hypertension (mean age, 52 years) underwent 24-h BP monitoring (spacelabs: 1 measure/15 min). Patients were subdivided into two groups: the "High" group, with 24-h mean values of systolic BP (SBP) > 137 or diastolic BP (DBP) > 87 mm Hg, and the "Low" group, with SBP < or = 137 and DBP < or = 87 mm Hg. All patients received, in a random and double-blind design, either bisoprolol (10 mg q.d.) or lisinopril (20 mg q.d.) for 8 weeks. At the end of this active treatment period, office and ambulatory BP measurements were performed. Casual measurements revealed similar BP decreases in all subgroups receiving bisoprolol and lisinopril; BP monitoring showed that the antihypertensive effect depended on the baseline mean 24-h value; -15/-12 mm Hg for bisoprolol and -18/-13 mm Hg for lisinopril in the High group; -7/-6 mm Hg for bisoprolol and -6/-6 mm Hg for lisinopril in the Low group. This study shows that the antihypertensive effect depended on initial ambulatory BP values, with a lower BP decrease in the Low group. Assessment of the antihypertensive effect on ambulatory BP is useful in clinical trials.

Psychological Characteristics and Responses to Antihypertensive Drug Therapy

“…Nevertheless, the dosages used were highly representative of usual clinical practice and were administered uniformly to all subjects. Further, the magnitude of the blood pressure reduction was comparable to that observed in other studies 56–59 …”

“…Further, the magnitude of the blood pressure reduction was comparable to that observed in other studies. [56][57][58][59] Knowledge of the subjects' history of responses to medications was unlikely to have biased the selection of subjects. Participants were entered strictly on the basis of meeting eligibility requirements and entry blood pressure criteria.…”

Therapeutic Properties of Highly Selective β-blockers With or Without Additional Vasodilator Properties: Focus on Bisoprolol and Nebivolol in Patients With Cardiovascular Disease

“…Similar in hypertension: lower central BP on celiprolol [108] -Metoprolol Similar in mild-to-moderate hypertension [109] Greater effect of bisoprolol on BP during exercise in hypertension [110] Similar in hypertension + intermittent claudication [20] RAAS blockers Captopril Similar in elderly patients with hypertension [111] -Lisinopril Similar in hypertension (effects on ambulatory BP) [112] Similar in mild-to-moderate hypertension [113] Similar in hypertension [130] Enalapril Similar in hypertension (office and 24 h BP) [114] Similar in mild-to-moderate hypertension [115] Similar in hypertension [131,132] -BP in hypertensive patients with autonomic failure, a condition that is known to respond to NO [140].…”