Comparison of angiotensin-converting enzyme inhibitors and calcium antagonists in the treatment of mild to moderate systemic hypertension, according to baseline ambulatory blood pressure level

Effect of Long-Term Antihypertensive Treatment on White-Coat Hypertension

“…This is an observation that could not be made in previous analyses of other interventional trials, 14,[17][18][19][20][21][22][23][24][25][26][27] because only in ELSA ABP was systematically measured before treatment and repeatedly during several years of treatment, 29 whereas in most other studies ABP monitoring was limited to a relatively small subgroup of patients or done during treatment only. As to the effects of treatment on office BP, our data were derived from a controlled trial, with treatment steps determined by protocol according to the achieved DBP.…”

“…15,16 Furthermore, the effect of treatment on ABP values of WCH individuals is by no means clear because the reports range from a marked ABP fall to an ABP fall with some drugs only to no ABP fall at all. 14,[17][18][19][20][21][22][23][24][25][26][27] Previous studies on the BP effects of antihypertensive treatment in WCH have usually assessed ABP by just one 24-hour recording, sometimes without a baseline reference value.14,28 Primary aim of the present study has been to address the issue in a more adequate fashion by taking advantage of the unique data provided by the European Lacidipine Study on Atherosclerosis (ELSA) trial, 29 the only prospective antihypertensive treatment trial in which all patients with moderate elevations of both systolic BP (SBP) and diastolic BP (DBP) had office and ABP measured (1) before randomization to treatment and (2) at 6-month (office BP) and 12-month (ABP) intervals during treatment over a follow-up of 4 years. The multiple office and ABP measurements during the treatment period allowed us to more properly address also other issues relevant to WCH, such as the modification with time of the difference between office and ABP, often defined as the WC effect, 14,30 and the effect of treatment on within 24 hours and visit-to-visit BP variability (short-and long-term variability) of WCH vis-à-vis sustained hypertensive individuals.…”

“…15,16 Furthermore, the effect of treatment on ABP values of WCH individuals is by no means clear because the reports range from a marked ABP fall to an ABP fall with some drugs only to no ABP fall at all. 14,[17][18][19][20][21][22][23][24][25][26][27] Previous studies on the BP effects of antihypertensive treatment in WCH have usually assessed ABP by just one 24-hour recording, sometimes without a baseline reference value.…”

Differential effects of antihypertensive drugs with differing pharmacological properties on the basal ambulatory blood pressure

“…Ashida et al 12 and Herpin et al 13 found that ACE inhibitors, but not Ca entry blockers, lowered the ambulatory BP in subjects with white coat hypertension, which is characterised by a high clinic BP and a normal ambulatory BP. One then asks: does this characteristic of ACE inhibitors have any clinical significance?…”

Treatment of white coat hypertension

“…On the other hand, Herpin et a1. [49] found that calcium channel blockers were ineffective in decreasing ABP in patients with white coat hypertension, whereas the angiotensin converting enzyme (ACE) inhibitors were effective. However, both classes of drugs were effective in reducing the clinic blood pressure.…”