The effect of telmisartan and ramipril on early morning blood pressure surge:: a pooled analysis of two randomized clinical trials

被引:25
作者
Gosse, Philippe
Neutel, Joel M.
Schumacher, Helmut
Lacourciere, Yves
Williams, Bryn
Davidai, Giora
机构
[1] Hop St Andre, Serv Cardiol Hydertens Arterielle, Hypertens Unit, F-33075 Bordeaux, France
[2] Orange Cty Res Ctr, Tustin, CA USA
[3] Boehringer Ingelheim Pharmaceut Inc, Res & Dev, Ridgefield, CT 06877 USA
[4] Boehringer Ingelheim Pharma GmbH & Co KG, Med Data Serv Dept, Ingelheim, Germany
[5] Quebec Hosp, Hypertens Res Unit, Ste Foy, PQ, Canada
[6] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
关键词
ambulatory blood pressure monitoring; early morning blood pressure surge; hypertension; ramipril; telmisartan;
D O I
10.1097/MBP.0b013e3280b10bbd
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Objectives The period of early morning blood pressure surge is associated with a higher incidence of cardiovascular events than at other times of the day. Antihypertensive medication given once daily in the morning may not protect against this surge if its duration of action is too short. We compared telmisartan, an angiotensin II receptor blocker with a trough-to-peak ratio >90%, with ramipril, an angiotensin-converting enzyme inhibitor with a trough-to-peak ratio of around 50%. Methods Data from two prospective, randomized, open-label, blinded endpoint studies comparing telmisartan force titrated to 80 mg once daily and ramipril 10 mg once daily were pooled. Patients had mild-to-moderate hypertension and were assessed using 24-h ambulatory blood pressure monitoring at baseline and endpoint. Early morning blood pressure surge was defined as the difference between mean blood pressure within 2 h after arising and night-time low. Patients were grouped into quartiles according to their baseline systolic surge. Results Data from 1279 patients were analyzed. Telmisartan changed the overall mean (SE) systolic surge by -1.5 (0.47) mmHg, and ramipril by +0.3 (0.47) mmHg (P = 0.0049). The magnitude of surge reduction was greatest in the quartile with highest baseline systolic surge: telmisartan -12.7 (0.91), ramipril -7.8 (1.02) mmHg (P = 0.0004). Telmisartan also reduced the surge compared with ramipril in dippers, but there were no differences between the two groups in nondippers. Conclusions Telmisartan significantly reduced the early morning systolic blood pressure surge compared with ramipril. A reduction in this surge may help to reduce cardiovascular events in the morning period.
引用
收藏
页码:141 / 147
页数:7
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