Importance of trough : peak ratios in treatment of blood pressure in post-myocardial infarction and heart failure settings

Modesti, Pietro Amedeo

doi:10.1038/sj.jhh.1000399

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…Moreover, trough-to-peak ratios for both DBP and SBP on ABPM at week 14 of treatment were higher in the azilsartan group than in the candesartan group, providing further evidence of a longer duration of action of azilsartan relative to candesartan. 19 …”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study

et al. 2012

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Azilsartan is a novel angiotensin receptor blocker being developed for hypertension treatment. This 16-week, multicenter, randomized, double-blind study compared the efficacy and safety of azilsartan (20–40 mg once daily by forced titration) and its ability to provide 24-h blood pressure (BP) control, with that of candesartan cilexetil (candesartan; 8–12 mg once daily by forced titration) in 622 Japanese patients with grade I–II essential hypertension. Efficacy was evaluated by clinic-measured sitting BP, and by ambulatory BP monitoring (ABPM) at week 14. Participants (mean age: 57 years, 61% males) had a mean baseline sitting BP of 159.8/100.4 mm Hg. The mean change from baseline in sitting diastolic BP at week 16 (primary endpoint) was −12.4 mm Hg in the azilsartan group and −9.8 mm Hg in the candesartan group, demonstrating a statistically significant greater reduction with azilsartan vs. candesartan (difference: −2.6 mm Hg, 95% confidence interval (CI): −4.08 to −1.22 mm Hg, P=0.0003). The week 16 (secondary endpoint) mean change from baseline in sitting systolic BP was −21.8 mm Hg and −17.5 mm Hg, respectively, a significant decrease with azilsartan vs. candesartan (difference: −4.4 mm Hg, 95% CI: −6.53 to −2.20 mm Hg, P<0.0001). On ABPM, the week 14 mean changes from baseline in diastolic and systolic BP were also significantly greater with azilsartan over a 24-h period, and during the daytime, night-time and early morning. Safety and tolerability were similar among the two groups. These data demonstrate that once-daily azilsartan provides a more potent 24-h sustained antihypertensive effect than that of candesartan but with equivalent safety.

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Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study

et al. 2012

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How to Evaluate the Duration of Blood Pressure Control: The Trough:Peak Ratio and 24-Hour Monitoring

Meredith

1998

Journal of Cardiovascular Pharmacology

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Recently published data provide confirming evidence to support existing epidemiologic data showing that treatment-induced changes in 24-h blood pressure are more closely correlated with treatment-induced changes in left ventricular mass index than corresponding changes in clinic blood pressure. This provides definitive support for the aim of achieving blood pressure control based on a smooth and consistent antihypertensive effect over a full 24-h period. With the plethora of agents now available for once-daily administration in the treatment of hypertension, it would be of value to have a validated index that defines duration of effect and that discriminates between alternative treatments and treatment regimens. The trough:peak ratio of blood pressure response has been proposed as such as index and has in part been validated in this role. Evidence suggests that many existing agents have suboptimal trough:peak ratios or, alternatively, that achieving a high ratio is dependent on utilizing inappropriately high doses of drug. Where a drug has a high trough:peak ratio that is associated with its intrinsic long duration of action and is independent of dose over the therapeutic range, the evidence indicates that the drug may offer the additional benefit of sustained blood pressure control after a missed dose. Finally, theoretic and experimental evidence supports the concept that rational drug combinations will produce enhanced trough:peak ratios compared to the individual drug components.

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Trandolapril

Peters¹,

Noble²,

Plosker³

1998

Drugs

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trandolapril has a favourable pharmacological profile and an antihypertensive efficacy at least comparable to that of other ACE inhibitors. The pharmacological characteristics of trandolapril allow it to provide good 24-hour control of BP with once-daily administration. Trandolapril has also demonstrated some efficacy in a small number of patients with CHF. In addition, trandolapril provides long term protection against all-cause mortality in patients with LV dysfunction after MI. The results of the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) study will determine its potential as a cardioprotective agent in patients with coronary artery disease and preserved LV function. Thus, trandolapril represents an effective, well-tolerated and convenient treatment option for patients with mild to moderate hypertension or LV systolic dysfunction after MI.

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Importance of trough : peak ratios in treatment of blood pressure in post-myocardial infarction and heart failure settings

Cited by 4 publications

References 4 publications

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study

How to Evaluate the Duration of Blood Pressure Control: The Trough:Peak Ratio and 24-Hour Monitoring

Trandolapril

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