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Balanced 24-hour blood pressure control by angiotensin-converting enzyme inhibitors administered once daily
G Parati1, A Ravogli, S Trazzi
1Department of Internal Medicine, Ospedale Maggiore, Milan University of Studies, Italy.
Insights
Traditional blood pressure cuffs can be inaccurate. Twenty-four-hour ambulatory blood pressure monitoring offers a superior, dynamic assessment, especially for evaluating once-daily antihypertensive treatments like ACE inhibitors.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Traditional sphygmomanometry may provide inaccurate 24-hour blood pressure readings due to limited measurements and patient responses to physicians.
- Ambulatory blood pressure monitoring (ABPM) is superior for diagnosing hypertension and assessing treatment efficacy.
- ABPM offers dynamic blood pressure evaluation over 24 hours, crucial for assessing once-daily antihypertensive drug effectiveness.
Purpose of the Study:
- To evaluate the effectiveness of once-daily antihypertensive treatments, specifically ACE inhibitors, in providing 24-hour blood pressure control.
- To assess the impact of ACE inhibitors on cardiovascular homeostasis and baroreceptor function.
Main Methods:
- Utilized 24-hour ambulatory blood pressure monitoring (ABPM) techniques.
- Compared ABPM data with traditional sphygmomanometric measurements.
- Examined the effects of once-daily ACE inhibitor administration on blood pressure and heart rate variability.
Main Results:
- Once-daily ACE inhibitors demonstrate sustained 24-hour blood pressure control, balancing day and night levels.
- ACE inhibitor treatment did not appear to disrupt neural mechanisms of cardiovascular homeostasis.
- These drugs did not alter 24-hour blood pressure and heart rate variability.
- Arterial baroreceptor sensitivity remained unaltered or was enhanced during ACE inhibitor administration.
Conclusions:
- Long-acting ACE inhibitors are potentially important for managing arterial hypertension.
- ABPM is a valuable tool for assessing the 24-hour efficacy of antihypertensive treatments.
- ACE inhibitors provide balanced, long-term blood pressure control without compromising cardiovascular regulatory mechanisms.
Abstract:
Traditional sphygmomanometric measurements may inaccurately reflect the actual blood pressure level over a 24-h period. This is due to several factors which are known to affect cuff blood pressure readings, including the limited number of readings obtainable throughout the 24 h and the alerting reaction and pressor response induced in patients by the presence of the physician. Twenty-four-hour ambulatory blood pressure monitoring has been reported to be superior to isolated cuff blood pressure readings in the diagnostic evaluation of hypertension and in assessing the blood pressure response to treatment. It does not trigger any emotionally induced pressor reaction and is able to provide a dynamic evaluation of blood pressure profiles over 24 h. The latter feature is particularly important in assessing the ability of once-daily antihypertensive treatment to reduce and maintain blood pressure at an appropriate level throughout the 24-h period. Studies to date using ambulatory blood pressure monitoring techniques suggest that once-daily administration of certain ACE inhibitors is capable of providing this long-term control of blood pressure. The 24-h antihypertensive action exerted by once-daily administration of ACE inhibitors is characterized by balanced blood pressure control throughout the day and night, and treatment does not appear to alter the neural mechanisms responsible for cardiovascular homeostasis, as suggested by the fact that these drugs have been shown not to affect 24-h blood pressure and heart rate variability. Furthermore, during administration of ACE inhibitors the sensitivity of arterial baroreceptor control of circulation is unaltered or even enhanced. These observations emphasise the potential importance of long-acting ACE inhibitors in the control of arterial hypertension.