Relevance of blood pressure variation in the circadian onset of cardiovascular events

Ambulatory blood pressure monitoring (ABPM) is a highly useful diagnostic tool as it can detect non-dipping and can distinguish masked hypertension, white-coat hypertension and sustained hypertension. Furthermore, measurement of blood pressure using ABPM has greater prognostic strength than single clinic blood pressure measurements. The Systolic Hypertension in Europe study, for example, found that elevation of ambulatory systolic blood pressure, but not conventional single cuff systolic blood pressure, by 10 mmHg was associated with adverse cardiovascular outcomes. Blood pressure follows a circadian rhythm, with peak levels during the morning hours. The morning period has also been associated with a greater risk for cardiovascular events compared with the rest of the 24 h. The morning surge in blood pressure, along with haemostatic changes that promote thrombosis, is believed to contribute to this heightened risk. Long-acting anti hypertensive agents that provide blood pressure control throughout the 24-h dosing interval, including the morning hours, are the most appropriate therapeutic approach to hypertension. Direct comparative studies with telmisartan and other angiotensin-II receptor blockers and with amlodipine have shown that telmisartan has a long duration of action and controls blood pressure over the 24-h dosing period. (C) 2003 Lippincott Williams Wilkins.