Importance of smooth and sustained blood pressure control in preventing cardiovascular morbidity and mortality.
Current management guidelines in hypertension define the magnitude of blood pressure lowering required from antihypertensive therapy to favourably alter cardiovascular prognosis. In addition, however, the manner in which blood pressure is reduced also influences outcome, and antihypertensive therapy should induce smooth and sustained blood pressure control throughout the 24-h dosing interval. Ambulatory blood pressure recording techniques, in particular, have allowed the quantitative measurement of parameters such as the short-term variability of blood pressure, which correlates significantly with cardiovascular damage in patients with hypertension. The smoothness index has been developed as an index of the homogeneity of the blood pressure reduction obtained over the 24 hours by any given treatment during a long-term trial in patients with hypertension. This parameter is more predictive of a favourable effect of antihypertensive therapy (regression of left ventricular hypertrophy) during antihypertensive therapy than the widely used trough:peak ratio. The smoothness index is a useful new tool for comparing the quality of blood pressure lowering with different antihypertensive agents. For example, candesartan cilexetil, a potent and long-acting AT1-receptor blocker, increased the smoothness index by a significantly greater extent than the prototype AT1-receptor blocker, losartan, implying a more smooth and sustained antihypertensive effect.
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Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Ospedale San Gerardo di Monza, Italy. giuseppe.mancia@unimib.it
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D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002940:Circadian Rhythm / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D000959:Antihypertensive Agents