The 24-hour blood pressure pattern: does it have implications for morbidity and mortality?

Area of Science:

• Cardiology
• Pharmacology
• Circadian Biology

Background:

• Adverse cardiovascular events exhibit a morning peak, coinciding with physiological surges like blood pressure.
• Blood pressure variability is an independent risk factor for hypertensive target organ damage.
• Effective antihypertensive therapy requires sustained 24-hour control, especially during vulnerable morning hours.

Purpose of the Study:

• To evaluate the 24-hour blood pressure-controlling properties of telmisartan, an angiotensin II receptor antagonist.
• To investigate the potential cardiovascular benefits of telmisartan monotherapy versus ramipril monotherapy or combination therapy in high-risk patients.
• To explore the advantages of combining an angiotensin-converting enzyme inhibitor with an angiotensin II receptor antagonist.

Main Methods:

• Ambulatory blood pressure monitoring was used to assess telmisartan's properties.
• The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) compares telmisartan 80 mg, ramipril 10 mg, and their combination.
• Participants are patients at high risk for cardiovascular events, many with baseline hypertension.

Main Results:

• Clinical trials indicate telmisartan provides smooth and sustained 24-hour blood pressure control.
• ONTARGET will assess the impact of telmisartan and ramipril therapies on cardiovascular morbidity and mortality.
• The study design allows for the evaluation of combined ACE inhibitor and ARB therapy.

Conclusions:

• Telmisartan demonstrates favorable pharmacokinetic properties for managing morning blood pressure surges.
• The ONTARGET trial is crucial for determining if telmisartan's attributes translate to improved cardiovascular outcomes.
• Investigating combination therapy may reveal synergistic benefits in high-risk cardiovascular patients.