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      A Comparison of Selected Antihypertensives and the Use of Conventional vs Ambulatory Blood Pressure in the Detection and Treatment of Hypertension

      Cardiology

      S. Karger AG

      Hypertension, Antihypertensive therapy, Ambulatory blood pressure monitoring

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          Abstract

          This multicenter, randomized, double-blind, parallel group study was undertaken to determine the effectiveness of selected antihypertensives (doxazosin, amlodipine, enalapril, and bendrofluazide) in maintaining 24-hour control of blood pressure (BP). The predictive value of ambulatory (A)BP versus clinic (C)BP measurements as a method for detecting patients with hypertension was also evaluated. A total of 204 patients were screened and of these 110 were diagnosed as mild to moderately hypertensive with clinic diastolic BP 100–110 mm Hg (≧95 mm Hg in patients with coronary heart disease risk factors). The 4 antihypertensives were all equally effective at controlling BP over 24 h, as shown by 24-hour ABP measurements. The incidence of adverse events was similar for all 4 treatment groups; headache was the most common event, being reported by 22 patients (20%). There was a clinically relevant reduction in total cholesterol for the doxazosin (–15.4 mg/dl) and amlodipine (–11.6 mg/dl) treatment groups in comparison with enalapril and bendrofluazide. Our results from ABP measurements suggest that the antihypertensives studied are effective first-line therapy in the regulation of hypertension and that ABP is a reproducible measure. ABP may also be useful in identifying patients with various types of high BP, for instance those with ‘white coat’ hypertension, enabling more accurate screening and diagnosis.

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          Most cited references 8

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          Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease

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            1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension

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              Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators.

              Ambulatory blood pressure (ABP) monitoring is used increasingly in clinical practice, but how it affects treatment of blood pressure has not been determined. To compare conventional blood pressure (CBP) measurement and ABP measurement in the management of hypertensive patients. Multicenter, randomized, parallel-group trial. Family practices and outpatient clinics at regional and university hospitals. A total of 419 patients (> or =18 years), whose untreated diastolic blood pressure (DBP) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP or ABP arms. Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the average daytime (from 10 AM to 8 PM) ambulatory DBP (n=213) or the average of 3 sitting DBP readings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below (<80 mm Hg) target, 1 physician blinded to the patients' randomization intensified antihypertensive treatment, left it unchanged, or reduced it, respectively. The CBP and ABP levels, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and cost. At the end of the study (median follow-up, 182 days; 5th to 95th percentile interval, 85-258 days), more ABP than CBP patients had stopped antihypertensive drug treatment (26.3% vs 7.3%; P<.001), and fewer ABP patients had progressed to sustained multiple-drug treatment (27.2% vs 42.7%; P<.001). The final CBP and 24-hour ABP averaged 144.1/89.9 mm Hg and 129.4/79.5 mm Hg in the ABP group and 140.3/89.6 mm Hg and 128.0/79.1 mm Hg in the CBP group. Left ventricular mass and reported symptoms were similar in the 2 groups. The potential savings in the ABP group in terms of less intensive drug treatment and fewer physician visits were offset by the costs of ABP monitoring. Adjustment of antihypertensive treatment based on ABP monitoring instead of CBP measurement led to less intensive drug treatment with preservation of blood pressure control, general well-being, and inhibition of left ventricular enlargement but did not reduce the overall costs of antihypertensive treatment.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                978-3-8055-7309-2
                978-3-318-00774-9
                0008-6312
                1421-9751
                2001
                2001
                08 November 2001
                : 96
                : Suppl 1
                : 3-9
                Affiliations
                Didcot Health Centre, Didcot, UK
                Article
                49095 Cardiology 2001;96(suppl 1):3–9
                10.1159/000049095
                11574740
                © 2001 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 4, Tables: 2, References: 23, Pages: 7
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