importance of consistent 24-hour blood pressure control
TRANSCRIPT
THE JOURNAL OF CLINICAL HYPERTENSION SUPPLEMENT 1 VOL. IV NO. IV JULY/AUGUST 20022
Effective management of hypertension should beaimed at reducing blood pressure (BP) while
protecting patients against adverse cardiac events.Of particular concern is the need to suppress theearly morning surge in BP. This circadian fluctua-tion coincides with a time interval during which pa-tients are at increased risk of myocardial infarction,angina, stroke, and sudden cardiac death. Circadi-an variation in BP is an important consideration inthe selection of appropriate therapeutic regimensfor hypertensive patients.
This supplement of The Journal of Clinical Hy-pertension examines two important issues in theregulation of circadian patterns in hypertension.The first is the prognostic value of BP variationsthroughout the 24-hour period, and the second ishow treatment with antihypertensive drugs, such ascalcium antagonists and angiotensin II receptorblockers (ARBs), affects BP cycles.
The first review, by Dr. Pierre Larochelle, definesthe circadian nature of various endocrine and hema-tologic parameters that affect BP and that may trig-ger cardiovascular events. Endocrine changes that
blunt or prevent the normal nighttime decrease in BPare associated with increased morbidity. ARBs, suchas telmisartan, may limit the morning surge in BPthrough effects on the renin-angiotensin-aldosteroneand noradrenergic systems.
In the second review, one of us (Dr. Mancia) re-views data showing that ambulatory BP monitoringis predictive of cardiovascular events in hypertensivepatients. Mean arterial pressure, daytime BP, night-time BP, and BP variability throughout the day areprognostic. Blood pressure variability may be in-creased with the use of rapidly metabolized drugs,which thereby reduce the therapeutic benefits.
Dr. Peter Meredith reviews FDA regulations re-garding fluctuations in BP control throughout thefull 24-hour period. Drugs in different classes, suchas ARBs and calcium antagonists, may differ in theconsistency of their effects on BP. Indeed, differ-ences in BP regulation may be observed in drugswithin the same class.
Finally, we have included two reviews on the useof antihypertensive agents to control blood pressurethroughout the 24-hour dosing interval. The first, byDr. George Bakris, presents ambulatory blood pres-sure monitoring data from a direct comparative studyof telmisartan and valsartan; the second, by Dr.William White, includes ambulatory blood pressuremonitoring data from a direct comparative study oftelmisartan and amlodipine.
These presentations, as a whole, support the im-portance of achieving smoother, more consistent BPcontrol to prevent cardiovascular and cerebrovascu-lar events. They also demonstrate how understand-ing the impact of circadian fluctuations in BP aids inassessment of treatments for hypertension.
I n t r o d u c t i o n
Importance of Consistent 24-Hour BloodPressure Control
Giuseppe Mancia, MD, PhD;1 Michael Weber, MD2
From Clinica Medica, Dipartimento di Medicine Clinica,Prevenzione e Biotecnologie Sanitarie, Università degliStudi Milano-Bicocca, Milan, Italy;1 and the State Univer-sity of New York Health Science Center, Brooklyn, NY2
Address for correspondence: Giuseppe Mancia, MD, PhD, Clinica Medica, Univer-sità degli Studi Milano-Bicocca, Azienda OspedalieraSan Gerardo di Monza, Via Donizetti 106-20052,Monza (MI), ItaliaE-mail: [email protected] received January 23, 2002;accepted February 6, 2002