Impact of antihypertensive combination and monotreatments on blood pressure variability

Abstract

As compared with various monotherapies, the telmisartan/amlodipine combination was associated with a smoother BP reduction over 24 h and with a more favourable balance between mean 24-h BP reduction and the degree of BP variability on treatment, reflecting both its effectiveness in lowering BP levels and its longer duration of action. The agreement between smoothness index and TOVI demonstrates that they are similarly effective in the differentiation of antihypertensive treatments, although providing conceptually different information, the clinical relevance of which needs to be tested by ad-hoc outcome studies.

Effect of antihypertensive treatment on 24-h blood pressure variability

“…This was carried out according to the intention-to-treat principle, including only study participants with valid ABPM recordings at baseline and at the end of the double-blind treatment period, even in presence of major protocol violations. The efficacy variables considered for the present individual pooled data analysis were: average of all BP values collected over the 24 h, the day (0700 to 2300 h) and the night (2300 to 0700 h); 24 h, day and night unweighted SD, defined as the SD of the 24 h, day or night mean BP value [ 14 ]; the 24-h weighted SD, defined as the SD of the average of all BP values during the day and the night, with weights corresponding to the duration of the daytime and night-time [ 15 ]; the ARV, for the 24-h and for the day and night, defined as the mean of the successive absolute differences between adjacent BP values [ 16 ]; 24 h, day and night variation coefficient, calculated by dividing the unweighted SD and ARV by the corresponding mean BP value; 24-h variation coefficient for weighted SD, calculated by dividing the weighted SD by the mean BP value; TPR, computed in each study participants by dividing the BP changes at trough (last 2 h of the monitoring period) by those at peak (average of the adjacent 2 h with the maximal BP reduction between the second and 8 h from the drug intake [ 38 ]; smoothness index, obtained by dividing the mean of hourly BP reductions and the SD of the average hourly differences [ 19 ]; TOVI, defined by the ratio between the mean of the 24-h BP reductions with treatment and the 24-h weighted SD, or the 24-h ARV, during treatment [ 21 ]. All variables were separately assessed for SBP and DBP.…”

“…A large smoothness index usually indicates a consistent average BP reduction associated with a small variability among hours, and thus a superior cardiovascular protection and an improved prevention of target-organ damage [ 19 , 20 ]. The TOVI is computed as the ratio between the changes in 24-h mean BP and the 24-h SD of BP during treatment [ 21 ]. It represents an alternative measure of the effects of antihypertensive treatment on both mean BP levels and BPV, combining information on the reduction of 24-h average BP values and on the accompanying changes in short-term absolute 24-h BPV during treatment.…”

“…It represents an alternative measure of the effects of antihypertensive treatment on both mean BP levels and BPV, combining information on the reduction of 24-h average BP values and on the accompanying changes in short-term absolute 24-h BPV during treatment. Preliminary evidence suggest that the TOVI, although providing conceptually different information from the smoothness index, is as effective as the smoothness index in differentiating the size and the duration of the antihypertensive effect of different treatments [ 21 ].…”

<p>Study on the Formation of Antihypertensive Twin Drugs by Caffeic Acid and Ferulic Acid with Telmisartan</p>

“…160.5~162.2°C. Ferulic acid ethyl ester (4). The product was obtained as a white solid (74.40% yield); m.p.…”

“…Telmisartan is an angiotensin II receptor antagonist and has a strong antihypertensive effect, but telmisartan is not a good suppressor of blood pressure fluctuations during antihypertensive process. [1][2][3][4] High blood pressure variability (BPV) is an important cause of cardiovascular diseases and can cause damage to the target organs of hypertension. [5][6][7] Endothelin 1 (ET-1), which has a strong contraction of blood vessels, could promote the mitotic effect of smooth muscle cells, and is closely related to a variety of heart and cerebrovascular disease.…”