Evaluation of the antihypertensive effect of once-a-day trandolapril by 24-hour ambulatory blood pressure monitoring

Mancia, Giuseppe; Cesaris, R. De; Fogari, Roberto; Lattuada, S; Montemurro, G; Palombo, Carlo; Porcellati, Carlo; Ranieri, G.; Tettamanti, F.; Verdecchia, Paolo; Marelli, Claudio; Omboni, Stefano; Ravogli, Antonella; Zanchetti, Alberto

doi:10.1016/0002-9149(92)90273-2

Cited by 30 publications

(14 citation statements)

References 11 publications

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“…1 This occurs with a variety of antihypertensive treatments, that is, angiotensinconverting enzyme inhibitors, calcium channel blockers, central agents, and ␤-blockers without or with vasodilator properties given alone or in combination with a diuretic, [9][10][11][12][13][14][15][16][17] suggesting that this is the consequence of BP lowering, per se. Interestingly, in most instances the reduction of the SD has been found to be proportional to the reduction of the mean BP value with, thus, little or no change in the BP coefficient of variation.…”

Section: Effect Of Antihypertensive Treatmentmentioning

confidence: 99%

Short- and Long-Term Blood Pressure Variability

2012

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It has long been known that blood pressure (BP) is characterized by an array of spontaneous variations.1 That is, BP values vary markedly within the 24 hours because of day-night changes but also because of differences among hours, minutes, and even adjacent beats. They also show variations over more prolonged periods because of differences among days, months, and seasons, 2 also with a trend for systolic BP to increase over the years and for diastolic BP to display an age-related biphasic change. 3This article summarizes current knowledge on short-term (within the 24 hours) and long-term BP variability. Mention will be made of the following: (1) factors responsible for BP variations and mechanisms through which they occur; (2) the relationship of BP variability with BP mean values in absence and during antihypertensive treatment; and (3) the prognostic significance of BP variability. Current limitations of the studies on BP variability will be also discussed to emphasize what future studies should address. Twenty-Four Hour BP Variability Factors and MechanismsA large body of evidence shows that, over the 24 hours, BP undergoes marked variations in response to physical activity, sleep, and emotional stimuli of various nature and duration, thereby documenting the profound involvement of behavioral influences on BP variability. However, spontaneous BP variations also occur independently on behavior. For example, throughout the day and night, BP oscillates regularly at different frequencies, presumably because of influences originating within the brain. 4 Furthermore, BP varies more or less regularly in response to the mechanical forces generated by ventilation and also shows irregular nonbehaviorally and nonmechanically related changes with a possible origin from humoral influences and even local vasomotor phenomena. Finally, BP variations are opposed throughout the 24 hours by the baroreflex, which makes the magnitude of 24-hour BP variability in a given individual the net effect of prooscillatory and antioscillatory influences.1 Some of these influences operate via the sympathetic nervous system, 5 but nonneural mediators are also importantly involved, as shown by the complex effects of sympathectomy on BP variability in experimental animals, that is, the disappearance of some variability components with the persistence or even the increase of others. 6 The factors possibly responsible for 24-hour BP variability are illustrated in Figure 1. Relationship With 24-Hour BP MeanEarly studies with intra-arterial ambulatory BP monitoring have shown that 24-hour, daytime, and nighttime BP variabilities (quantified as the SD of the 24-hour, day, and night mean values) increase from normotensives to patients with a progressively more severe hypertension 7 (Figure 2, top left). They have further shown that an increase of BP variability when BP mean increases also occurs within individuals, because the BP SD becomes progressively greater from the half hours in which mean BP is lowest to the half hours in which it is maximal...

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Section: Effect Of Antihypertensive Treatmentmentioning

confidence: 99%

Short- and Long-Term Blood Pressure Variability

2012

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“…Long-acting angiotensin-converting enzyme (ACE) inhibitors have been reported to lower the ambulatory BP without disruption of its diurnal variation (33). However, a specifically timed administration of the long-acting lipophilic ACE inhibitor trandolapril just before going to bed may achieve a greater reduction of morning BP in hypertensives.…”

Section: Introductionmentioning

confidence: 99%

Effects of Bedtime vs. Morning Administration of the Long-Acting Lipophilic Angiotensin-Converting Enzyme Inhibitor Trandolapril on Morning Blood Pressure in Hypertensive Patients

Kuroda

Kario²,

Hashimoto³

et al. 2004

Hypertens Res

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“…[2][3][4][5][6] In consequence, values for T:P ratios reported for the same drug vary greatly according to the method of calculation. [7][8][9][10] BP is subject to short-lived fluctuations, linked to factors such as physical activity, mental stress and meal times. These fluctuations influence the calculation of the antihypertensive response to drugs.…”

Section: Introductionmentioning

confidence: 99%

The use of Fourier analysis in the calculation of trough to peak ratio from ambulatory blood pressure measurements

Diamant

Vincent

1998

J Hum Hypertens

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The trough:peak (T:P) ratio serves as an index of efficacy of antihypertensive drugs with respect to their dose and dose interval. There is no consensus regarding the method for the calculation of the T:P ratio. We assessed the influences of curve smoothing, the average fall in 24-h mean arterial pressure (MAP) and the length of the peak effect period on the result of T:P ratio calculation. Forty-two patients with essential hypertension (aged 27-81 years; 20 males) had a 24-h ambulatory blood pressure (BP) measurement on two occasions. The first was performed at baseline, the second after 12 weeks of treatment with a ␤-blocker, angiotensin-converting enzyme inhibitor, calcium slowchannel blocker, diuretic or a centrally acting drug, all taken once daily. BP data were analysed both by Fourier analysis (FA) with four harmonics and by time block analysis (TBA). The peak effect was defined as the maximum drop in MAP over a period of 0 to 3 h following drug intake at any time in the 24 h, and the trough effect as the fall in MAP over the last 2 h of the dose interval. FA gave higher T:P ratio values than TBA (0.51 vs 0.43;

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Evaluation of the antihypertensive effect of once-a-day trandolapril by 24-hour ambulatory blood pressure monitoring

Cited by 30 publications

References 11 publications

Short- and Long-Term Blood Pressure Variability

Short- and Long-Term Blood Pressure Variability

Effects of Bedtime vs. Morning Administration of the Long-Acting Lipophilic Angiotensin-Converting Enzyme Inhibitor Trandolapril on Morning Blood Pressure in Hypertensive Patients

The use of Fourier analysis in the calculation of trough to peak ratio from ambulatory blood pressure measurements

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