Trough to peak ratio as a guide to BP control: measurement and calculation

Lisinopril versus enalapril: evaluation of trough:peak ratio by ambulatory blood pressure monitoring

“…6 This rather arbitrary limit seems meaningless, however, unless the method by which the T:P ratio of a drug is determined is specified. 15,[17][18][19][20][21][22] In the last years, many excellent reviews addressing the methodology of T:P ratio assessment, especially from 24-h ABPM data, have been published. [15][16][17][18][19]21,22 In these papers, many recommendations have been made for calculation of T:P ratios.…”

“…15,[17][18][19][20][21][22] In the last years, many excellent reviews addressing the methodology of T:P ratio assessment, especially from 24-h ABPM data, have been published. [15][16][17][18][19]21,22 In these papers, many recommendations have been made for calculation of T:P ratios. Not only do these guidelines need validation in prospective studies, but also the value of the T:P ratio as an index of 24-h BP control still needs to be established, as there are no prospective studies showing a relation between T:P ratio and target organ damage.…”

“…[7][8][9][10][11][12][13][14] Recent studies critically addressing methods of T:P ratio calculation for once-daily antihypertensive agents, indicate that T:P ratios may be dose-dependent and that in individual patients the 0.50 criterion may not be met. [14][15][16][17][18][19] Recently, we have found that T:P ratios can be reliably calculated from 24-h ABPM data after Fourier analysis with four harmonics. 20 Furthermore, to prevent erroneous T:P ratio values, peakand trough-effect periods of 2 h each should be used and the peak effect should not be determined within a preset time window.…”

Twenty-four hour blood pressure control and trough to peak ratio: who, when, how and why?

“…One possible alternative is the 'missed dose response'. 1 A monitor is fitted and medication is taken at 8.00 am. The next day the patient misses the usual dose (ideally a matching placebo should be taken) and the monitor is removed at 2.00 pm.…”

“…In an accompanying editorial review, 1 we discussed the problems of how trough and peak (T:P) responses to antihypertensive drugs have been defined using ambulatory blood pressure monitors (ABPM). In this paper we address further problems related to the population in which these estimates should be done and how the data should be handled.…”