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Importance of smooth and sustained blood pressure control in preventing cardiovascular morbidity and mortality

G Mancia1, G Parati

  • 1Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Ospedale San Gerardo di Monza, Italy. giuseppe.mancia@unimib.it

Blood Pressure. Supplement
|October 31, 2001
PubMed

Insights

Smooth blood pressure control is crucial for hypertension management. The smoothness index effectively measures this, showing candesartan cilexetil offers more sustained effects than losartan.

Area of Science:

  • Cardiology
  • Pharmacology
  • Hypertension Management

Background:

  • Current hypertension guidelines focus on blood pressure lowering magnitude for cardiovascular prognosis.
  • The pattern of blood pressure reduction significantly impacts patient outcomes.
  • Ambulatory blood pressure monitoring enables quantification of blood pressure variability, linked to cardiovascular damage.

Purpose of the Study:

  • To introduce and evaluate the 'smoothness index' for assessing antihypertensive therapy quality.
  • To compare the smoothness index with the trough:peak ratio in predicting therapeutic effects.
  • To compare the smoothness of blood pressure reduction between candesartan cilexetil and losartan.

Main Methods:

  • Utilizing ambulatory blood pressure recording techniques.
  • Developing and applying the smoothness index to measure 24-hour blood pressure reduction homogeneity.
  • Comparing the smoothness index's predictive power against the trough:peak ratio for left ventricular hypertrophy regression.
  • Assessing the smoothness index for candesartan cilexetil versus losartan in a long-term trial.

Main Results:

  • The smoothness index quantifies the homogeneity of blood pressure reduction over 24 hours.
  • The smoothness index is a better predictor of favorable antihypertensive therapy effects (e.g., left ventricular hypertrophy regression) than the trough:peak ratio.
  • Candesartan cilexetil significantly increased the smoothness index compared to losartan.
  • This suggests candesartan cilexetil provides a smoother and more sustained blood pressure reduction.

Conclusions:

  • The smoothness index is a valuable tool for comparing the quality of blood pressure lowering by different antihypertensive agents.
  • Smooth and sustained blood pressure control throughout the 24-hour dosing interval is essential.
  • Candesartan cilexetil demonstrates a superior ability to achieve smooth and sustained blood pressure control compared to losartan.

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