How to evaluate the duration of blood pressure control: the trough:peak ratio and 24-hour monitoring.
Recently published data provide confirming evidence to support existing epidemiologic data showing that treatment-induced changes in 24-h blood pressure are more closely correlated with treatment-induced changes in left ventricular mass index than corresponding changes in clinic blood pressure. This provides definitive support for the aim of achieving blood pressure control based on a smooth and consistent antihypertensive effect over a full 24-h period. With the plethora of agents now available for once-daily administration in the treatment of hypertension, it would be of value to have a validated index that defines duration of effect and that discriminates between alternative treatments and treatment regimens. The trough:peak ratio of blood pressure response has been proposed as such as index and has in part been validated in this role. Evidence suggests that many existing agents have suboptimal trough:peak ratios or, alternatively, that achieving a high ratio is dependent on utilizing inappropriately high doses of drug. Where a drug has a high trough:peak ratio that is associated with its intrinsic long duration of action and is independent of dose over the therapeutic range, the evidence indicates that the drug may offer the additional benefit of sustained blood pressure control after a missed dose. Finally, theoretic and experimental evidence supports the concept that rational drug combinations will produce enhanced trough:peak ratios compared to the individual drug components.
Meredith
P A
PA
University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, Scotland.
D001794:Blood Pressure / Q000187:drug effects*; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D010349:Patient Compliance; D013997:Time Factors