title: Visit-to-visit variability and seasonal variation in blood pressure: Combination of Antihypertensive Therapy in the Elderly, Multicenter Investigation (CAMUI) Trial subanalysis.
abstract: BACKGROUND
  Combination antihypertensive therapy with an angiotensin receptor blocker (ARB) and a calcium channel blocker (CCB) or diuretics is common. This subanalysis investigated blood pressure (BP) variability in patients receiving ARB-based combination therapy.
  
  
  METHODS
  In a prospective, randomized, open-label trial, hypertensive outpatients (≥65 years) who did not achieve their target BP with ARB monotherapy switched to losartan 50 mg/hydrochlorothiazide 12.5 mg (ARB + D) or ARB plus amlodipine 5 mg (ARB + C) for 12 months. Clinic BP and heart rate (HR), measured every 3 months, visit-to-visit variability and seasonal variation were evaluated.
  
  
  RESULTS
  No significant between-group differences in average, maximum, or minimum systolic or diastolic BP, or HR, were found. Visit-to-visit BP variability (systolic) was significantly higher in the ARB + D group than in the ARB + C group. When each group was subdivided into two seasonal groups (summer and winter), no significant between-group differences in BP were found. Multivariate regression analyses showed a tendency toward negative correlation between outdoor temperature and urinary albumin:creatinine ratio and estimated glomerular filtration rate at 12 months in the ARB + D group.
  
  
  CONCLUSIONS
  Combination therapy with an ARB plus a CCB may be preferable to that with an ARB plus diuretics for decreasing BP variability. As for seasonal variability, both treatments can be used safely regardless of season.
authors: Department of Cardiology, Asahikawa Medical University , Asahikawa , Japan .
authors: Nobuyuki
authors: N
authors: Sato
authors: Yasuaki
authors: Y
authors: Saijo
authors: Yutaka
authors: Y
authors: Sasagawa
authors: Hideo
authors: H
authors: Morimoto
authors: Toshiharu
authors: T
authors: Takeuchi
authors: Hiroaki
authors: H
authors: Sano
authors: Satoshi
authors: S
authors: Koyama
authors: Naofumi
authors: N
authors: Takehara
authors: Kazutoyo
authors: K
authors: Morita
authors: Kazuhiro
authors: K
authors: Sumitomo
authors: Junichi
authors: J
authors: Maruyama
authors: Kenjiro
authors: K
authors: Kikuchi
authors: Naoyuki
authors: N
authors: Hasebe
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D019808:Losartan / Q000008:administration & dosage; D008297:Male; D011446:Prospective Studies; D012621:Seasons; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D017311:Amlodipine; D019808:Losartan
keywords: Antihypertensive agents; blood pressure variability; combination therapy; hypertension; renal outcome