Comparison of Antihypertensive Therapies by Noninvasive Techniques

Graettinger, William F.; Lipson, Jodi L.; Klein, Russell C.; Cheung, Deanna G.; Weber, Michael A.

doi:10.1378/chest.96.1.74

Cited by 23 publications

(18 citation statements)

References 21 publications

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“…The circadian pattern of blood pressure has been shown to be reproducible from day to day. Early studies with intra-arterial devices established that 24-h blood pres sure values are also reproducible, even when studied on separate days several weeks apart [10], Similar findings have been obtained with noninvasive techniques both in patients in hospital [11] and in ambulatory subjects under going their routine daily activities [12]. It should be remem bered, however, that there can be variations in individual subjects from 1 day of monitoring to another, particularly if there are differences in the type of activity undertaken during these days.…”

Section: Historysupporting

confidence: 56%

“…The advent of ambula tory devices, however, provides a convenient means of assessing efficacy during the early morning period. Several investigators, using whole-day monitoring to assess the duration of action of commonly used oncc-a-day antihy pertensive compounds, have reported a clear loss in effi cacy during the last 4-6 h of the 24-h dosing period [28,29], These findings suggest that many drugs marketed Whole-Day Ambulatory Blood Pressure in Hypertension as once-a-day agents do not maintain adequate control over the 24-h dosing interval and emphasize the impor tance of whole-day monitoring.…”

Section: Evaluation Of Treatmentmentioning

confidence: 99%

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Role of Whole-Day Ambulatory Blood Pressure Monitoring in the Management of Hypertension

Neutel¹

1996

Am J Nephrol

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As we learn more about hypertension, it is becoming increasingly apparent that conventional blood pressure measurements are fraught with potential error. Noninvasive ambulatory blood pressure monitoring is proving to be extremely valuable in both diagnosis and treatment. Advancing medical technology has provided small, noninvasive, reliable systems what are well tolerated by patients. The commercial availability of these systems facilitates their use in both clinical practice and in research. There have been legitimate concerns that continuous blood pressure monitoring may add considerably to the costs of diagnosing and treating hypertension. These worries, however, may be misplaced. If there are indeed as many patients being treated unnecessarily as has been suggested by many studies, then the money saved on drugs may well cover the costs of prolonged blood pressure monitoring. Moreover, many subjects can be spared unnecessary therapy. Although much work needs to be done with larger groups of patients followed over longer periods of time, the early experiences with 24-h ambulatory blood pressure monitoring have been extremely encouraging. These procedures have added to our understanding of hypertension and of the agents used in its treatment and are rapidly assuming an increasing importance in overall management.

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Section: Historysupporting

confidence: 56%

Section: Evaluation Of Treatmentmentioning

confidence: 99%

Role of Whole-Day Ambulatory Blood Pressure Monitoring in the Management of Hypertension

Neutel¹

1996

Am J Nephrol

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“…The results of trough to peak ratios from the above-mentioned study have to be interpreted carefully because blood pressure at the expected peak period was only measured twice. Graettinger et al (40) compared the antihypertensive effect of atenolol and lisinopril using ambulatory blood pressure measurements. In this study the trough to peak ratio for atenolol was clearly lower than 50%.…”

Section: -Blockers and The Trough To Peak Ratiomentioning

confidence: 99%

Treatment with β‐blockers—the value of an even plasma concentration over 24 h

Agewall

Kendall

1997

Journal of Clinical Pharmacy and Therapeutics

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SUMMARYThe aim of this paper was to examine if there were clinical studies supporting a beneficial effect of an even plasma concentration over 24 h for the most frequently prescribed 1-blockers in clinical practice, metoprolol CR/ZOK and atenolol. There are several studies showing that metoprolol CR/ZOK has a more even plasma concentration compared with atenolol and conventional metoprolol tablets when administered once daily. There are also studies showing that metoprolol CR/ZOK produces a more even 1-blockade over 24 h. This is determined by expressing the percentage reduction in exercise heart rate in relation to placebo at intervals throughout the 24-h period and comparing the results with those of atenolol and conventional metoprolol tablets. Clinical studies indicate that the low peak plasma concentration produced by metoprolol CR/ZOK leads to more 1 selectivity than atenolol and conventional metoprolol tablets. The loss of 1 selectivity at peak plasma concentrations may cause unwanted side-effects. The peak plasma concentration of atenolol coincides with increased general and leg fatigue, problems less evident when patients are on metoprolol CR/ZOK. The frequency and severity of other central nervous system related side-effects are comparable with metoprolol CR/ZOK and atenolol. In conclusion, there are several clinical studies supporting a beneficial effect of the even plasma concentration over 24 h achieved with metoprolol CR/ZOK.

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“…One subject experienced severe Raynaud's phenomenon during treatment with atenolol that resolved completely (Andren et al, 1982;Goldstein, 1990) Weber, 1988). By providing a substantial number of blood pressure values, this technique decreases withinsubject variation and greatly increases the power of blood pressure measurements (Coats et al, 1992 (Graettinger et al, 1989 (Lacourciere et al, 1990;Pickering et al, 1989). Indeed, although no study has so far systematically compared the responses to drug treatments with white coat and sustained hypertension, two studies found that calcium antagonists had relatively little effect on ambulatory pressure in patients with white coat hypertension, while they did lower ambulatory pressure in patients with more sustained hypertension (Lacourcire etal., 1990;Weber etal., 1988).…”

Section: Symptoms and Side Effectsmentioning

confidence: 99%

“…Finally, the titration of quinapril to the 'low maximum' dose of 20 mg and not the maximum 40 mg daily before adding the diuretic, due to the anticipated cumulative effect of both medications, could be another relevant factor. In fact, studies reporting a 24 h blood pressure control with ACE inhibitors have often used maximal dosages of the compounds (Graettinger et al, 1989;Portaluppi et al, 1990;Weinberger et al, 1990;Zachariah et al, 1988).…”

Section: Symptoms and Side Effectsmentioning

confidence: 99%