Effect of Antihypertensive Agents on Blood Pressure Variability

Abstract

Abstract-To investigate the effect of different antihypertensive agents on blood pressure (BP) variability (BPV) and the underlying mechanism, we analyzed the ambulatory BP monitoring data of 577 patients before and after 3-month antihypertensive treatment, in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study, a multicenter, multinational, randomized, double-blind, placebo-controlled study with 4 parallel treatment arms (placebo, candesartan, indapamide sustained release, and amlodipine). Within-subject mean and SD of 24-hour BP, weighted by time interval between consecutive readings, were calculated in 3 time frames (daytime, nighttime, and 24 hours) to evaluate BP and BPV. The mean 24-hour heart rate (HR) and HR variability were calculated with the same algorithms. We found that the 3 antihypertensive drugs had a similar BP-lowering effect (PϽ0.001 for all), but amlodipine (PϽ0.007) and indapamide sustained release (PϽ0.04) were the only agents associated with a significantly decreased BPV after 3-month treatment. On the other hand, the major determinants of BPV at baseline were age, mean BP, and the corresponding HR variability. However, the reduction in BPV by amlodipine was significantly associated with the reduction in BP (PϽ0.006) and the reduction in HR variability (PϽ0.02), whereas the corresponding reduction by indapamide sustained release was only associated with the reduction in HR variability at night (Pϭ0.004). In summary, 3-month amlodipine or indapamide sustained release treatment was associated with a significant reduction in BPV, and the mechanism of those reductions was possibly attributable to lowering BP or ameliorating the autonomic nervous system regulation or both. The combination of the 2 agents might help to optimize such properties. (Hypertension. 2011;58:155-160.)Key Words: ambulatory blood pressure monitoring Ⅲ calcium channel blocker Ⅲ diuretics Ⅲ blood pressure variability Ⅲ heart rate variability F or many decades, the main goal of antihypertensive treatment was to lower blood pressure (BP) to a defined level. Recently, several investigators have shown that BP variability (BPV) is another critical cardiovascular risk factor, which should also be emphasized in the treatment of hypertension. Mancia et al 1 were the first to report a close association of BPV, assessed by 24-hour ambulatory BP monitoring (ABPM), with target-organ damage in hypertensive patients. Carotid artery damage 1 and increased left ventricular mass index 2 were, therefore, investigated in the first instance. However, the predictive value of BPV concerning cardiovascular and all-cause mortality has long been a matter of debate. 3-9 More recently, nighttime BPV was considered to be a more pronounced risk factor than daytime BPV. 10,11 Finally, Rothwell 12 showed that visit-to-visit BPV was an independent and strong predictor of cardiovascular events, such as stroke and coronary heart disease, and calcium channel blockers and no...

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

“…Amlodipine treatment showed greater effects on short-term BPV variables in comparison with candesartan and indapamide sustained release (Figure 4) [90]. Specifically, after adjustment for the corresponding mean BP reduction, only amlodipine consistently ameliorated short-term BPV indexes, including daytime, nighttime, and 24 h SD of systolic BP and ARV [90].…”

“…In addition to these findings, the Natrilix SR versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study compared the impact of antihypertensive treatment with candesartan, indapamide sustained release, or amlodipine on SD of 24-hour ABPM in 577 patients [88,90]. Amlodipine treatment showed greater effects on short-term BPV variables in comparison with candesartan and indapamide sustained release (Figure 4) [90].…”

Порівняння Впливу Фіксованої Комбінації Периндоприл/Амлодипін На Ураження Органів-Мішеней У Пацієнтів З Артеріальною Гіпертензією З ішемічною Хворобою Серця Та Без Неї (Результати Дослідження EPHES)

“…В інших спостереженнях висока варіабельність АТ асоціювалася із зниженням пружно-еластичних властивостей артерій [18,19], наявністю атероскле-ротичних бляшок та збільшенням ниркового судин-ного опору [23]. На сьогодні існують вагомі докази того, що най-більш ефективними препаратами, які знижують варіабельність АТ, є діуретики та антагоністи каль-цію, а особливо амлодипін [44,54,58]. Окрім того, комбінація амлодипін + периндоприл у дослідженні ASCOT також продемонструвала властивість зни-ження варіабельності офісного АТ (рис.…”

Pediatric ambulatory blood pressure monitoring: diagnosis of hypertension

“…BPV has been shown to be predictive of stroke and other cardiovascular events in adults, and specific antihypertensive agents have been found to be superior to other drugs in reducing BPV and adverse vascular events [39][40][41]. Larger prospective pediatric studies are required in which BPV can be assessed as an additional independent factor contributing to cardiovascular risk in HTN, and to determine whether drugs and combinations of drugs that reduce both mean BP and BPV will have a beneficial effect on cardiovascular outcome.…”