title: Therapeutic effects of evening administration of guanabenz and clonidine on morning hypertension: evaluation using home-based blood pressure measurements.
abstract: OBJECTIVE
  To clarify the effects of bedtime administration of the centrally acting alpha(2)-agonists, guanabenz and clonidine, on morning hypertension.
  
  
  METHODS
  Patients with morning hypertension were assigned to receive once-daily evening administration of guanabenz (2 mg/day, n = 81; 4 mg/day, n = 2) or clonidine (75 microg/day, n = 40; 150 microg/day, n = 10) for 4 weeks, and the blood pressure (BP)-lowering effects of these drugs in the morning and evening were evaluated by assessing self-monitored BP in the home environment. The subjects were then subdivided into different groups according to their evening BP, and the effects of guanabenz and clonidine on evening BP were evaluated further for each group. In addition, as a substitute for the trough/peak ratio, the evening/morning (E/M) ratio was calculated to assess the duration of action of the two alpha(2)-agonists.
  
  
  RESULTS
  Evening dosing with guanabenz or clonidine lowered morning BP significantly. Both drugs decreased evening BP in the subgroup of subjects with a high evening BP, but not in those with a normal evening BP. The individual E/M ratios for guanabenz, but not for clonidine, were significantly greater in those with a high evening BP than in those with a normal evening BP. In the early treatment period, treatment with guanabenz resulted in a higher diastolic E/M ratio in those subjects with a high evening diastolic BP than did treatment with clonidine.
  
  
  CONCLUSIONS
  The results suggest that evening administration of the central alpha(2)-agonists guanabenz and clonidine effectively suppresses the morning BP elevation in treated hypertensive patients.
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Medicine and Pharmaceutical Science, Sendai, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Chonan
authors.forename: Yohei
authors.initials: Y
authors.lastname: Aoki
authors.forename: Takashi
authors.initials: T
authors.lastname: Ugajin
authors.forename: Junko
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Nishimura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Mari
authors.initials: M
authors.lastname: Michimata
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Matsubara
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Araki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D002940:Circadian Rhythm; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006143:Guanabenz / Q000008:administration & dosage* / Q000009:adverse effects; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D006143:Guanabenz; D003000:Clonidine