Ambulatory blood pressure monitoring after 1 year on valsartan or amlodipine-based treatment: a VALUE substudy.
OBJECTIVE
The ambulatory blood pressure (ABP) monitoring substudy of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial was carried out in a subset of patients from USA, Italy and Denmark. ABP was measured after 1 year in the trial, with the aim of evaluating comparability of ABP levels on valsartan (VAL) and amlodipine (AML)-based regimens.


METHODS
ABP was measured every 20 min during a 25-h period after morning administration of medicine; 659 patients were available for intention-to-treat analysis.


RESULTS
Office blood pressure (BP) differences were smaller than in the main study and mean ABP levels also showed only minor differences between the two regimens (VAL, 132.5/74.8 mmHg; AML, 131.5/75.2 mmHg). However, during the first 7 h after dosing, ABP was lower on VAL, whereas AML exerted a significantly stronger effect during the last 4 h of the dosing interval--possibly influencing the differences in office BP found in the main study. Mean heart rate (HR) was higher on AML (72.3 bpm) than on VAL (70.5 bpm) (P = 0.013), suggesting a sustained difference in sympathetic activation. Correlation analysis showed a close relationship between treated ABP levels and the occurrence of combined cardiovascular endpoints--superior to the relationship to office BP.


CONCLUSIONS
In these elderly high-risk patients, diastolic ABP levels tended to be less predictive than systolic, and daytime less predictive than night-time for all cardiovascular endpoints. The findings underline the importance of ABP substudies in comparative trials for elucidating significant differences in pharmacodynamics, and stresses the superior predictive power of ABP.
Pedersen
Ole Lederballe
OL
Sygehus Viborg,Viborg, Denmark. ole.lederballe@sygehusviborg.dk
Mancia
Giuseppe
G
Pickering
Thomas
T
Høegholm
Asbjørn
A
Julius
Stevo
S
Kjeldsen
Sverre E
SE
Nielsen
Eric S
ES
Refsgaard
Jens
J
Weber
Michael
M
D000367:Age Factors; D000368:Aged; D017311:Amlodipine / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D003718:Denmark; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012106:Research; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use*; D014481:United States; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
D000959:Antihypertensive Agents; D013777:Tetrazoles; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine