Twenty-four-hour blood pressure load as a surrogate end-point in assessing antihypertensive therapy.
OBJECTIVE
To examine the relationships among ambulatory blood pressure, blood pressure load (proportion of elevated blood pressure values over 24-h recording) and indices of hypertensive heart disease (left ventricular mass and left ventricular function) in untreated hypertensive patients. A secondary aim was to evaluate the usefulness of ambulatory blood pressure load in assessing the long-term effects of antihypertensive drug therapy.


METHODS
Data were obtained from a study of 15 men with moderate to severe essential hypertension who had been treated with a placebo followed by 6-8 months of carvedilol monotherapy (25-75 mg/day). Blood pressure was evaluated by 24-h ambulatory monitoring.


RESULTS
In studies of office or 'white-coat' hypertensives, ambulatory blood pressure has proved a better predictor of target organ involvement than casual (clinic) pressure. Blood pressure loads of > 50% for systolic pressure and > 40% for diastolic pressure are superior to clinic pressures, and also to the usual ambulatory monitoring parameters of mean 24-h, awake and sleeping blood pressure, in predicting left ventricular hypertrophy and abnormal diastolic performance. In the carvedilol study, the mean awake systolic blood pressure load fell from 94 to 43% and the diastolic blood pressure load fell from 84 to 27% with carvedilol treatment (P < 0.001 in both cases). Of the patients treated with carvedilol monotherapy, 60% fell into the lower risk category (< 50% systolic blood pressure and < 40% diastolic blood pressure load).


CONCLUSIONS
These data support the use of blood pressure load in clinical studies of mild to moderate essential hypertension as a measure of the efficacy of antihypertensive drugs.
Department of Medicine, University of Connecticut School of Medicine, Farmington 06030.
W B
WB
White
P
P
Lund-Johansen
P
P
Omvik
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*; D016037:Single-Blind Method; D013997:Time Factors
D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol