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Background: Blood pressure is characterized by a circadian rhythm, with lower values during sleep and periods of minimal activity, and higher values during the day and periods of mental and physical activity. An increased blood pressure variability has been reported to contribute independently to the higher cardiovascular risk of hypertensive patients; reducing this variability has therefore become an important goal of antihypertensive treatment. Objective: The aim of this study was to assess the ability of various calcium channel antagonists to reduce 24-hour average blood pressure and to study the effect of these agents on blood pressure variability, particularly on the blood pressure variations between day and night and the slope of the blood pressure increase that typically occurs in the morning at awakening. Methods: A total of 110 patients with grade 1 or grade 2 essential hypertension (diastolic blood pressure 90–109 mm Hg) were randomly assigned to receive nifedipine slow release (SR) 20 mg BID (n = 20), nifedipine gastrointestinal therapeutic system 60 mg QD (n = 20), amlodipine 10 mg QD (n = 20), felodipine extended release (ER) 10 mg QD (n = 15), verapamil SR 240 mg QD (n = 20), or lercanidipine 10 mg QD (n = 15) for 4 months. Each patient's blood pressure was monitored in ambulatory conditions over 24 hours before treatment and after 2 and 4 months of treatment. The 24-hour, daytime, nighttime, and hourly average values and trough-to-peak ratios were computed. Original data series were also analyzed by means of a Fourier model with 4 harmonics, and the blood pressure increase per time unit in the morning was computed. Results: The study sample included 60 men and 50 women (mean age ± SD, 53.2 ± 1.9 years). Based on the Fourier analysis, all patients in each treatment group experienced improvement in their blood pressure profile. With the exception of felodipine ER, all the compounds studied induced a significant ( P P Conclusions: Given the link between blood pressure fluctuations and cardiovascular risk, all new antihypertensive drugs should be tested for their ability not only to reduce 24-hour mean blood pressure levels, but also to maintain physiologic 24-hour blood pressure profiles and to prevent excessive blood pressure fluctuations. |
