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Comparative Effect of Dual-Combination Antihypertensive Regimens on Reducing 24-Hour Systolic Blood Pressure
Objectives:
This retrospective cohort study evaluated the real-world clinical effects of four dual-combination antihypertensive regimens on 24-hour ambulatory blood pressure variability (BPV) and circadian rhythm modifications over a 24-week period.
Methods:
A total of 302 adults with primary hypertension were evaluated across parallel cohorts: an angiotensin-converting enzyme inhibitor plus calcium channel blocker group (ACEi+CCB, n = 76), an angiotensin II receptor blocker plus thiazide diuretic group (ARB+Thiazide, n = 75), a beta-blocker plus thiazide group (BB+Thiazide, n = 74), and a calcium channel blocker plus beta-blocker group (CCB+BB, n = 77). 24-hour systolic blood pressure (SBP) standard deviation (SD), Coefficient of Variation (CV), and night-to-day SBP ratios were analyzed to assess hemodynamic variations independent of absolute blood pressure lowering.
Results:
While all regimens significantly reduced mean office and 24-hour ambulatory blood pressure, the ACEi+CCB combination demonstrated a significantly greater reduction in the 24-hour systolic CV from baseline to week 24 (from 10.35% ± 1.25% to 7.45% ± 0.92%, a relative drop of -28.0%) compared to the ARB+Thiazide (-15.1%), CCB+BB (-14.4%), and BB+Thiazide (-4.8%) cohorts (p < 0.001 after adjusting for absolute BP reduction). Additionally, the ACEi+CCB group achieved a significant downward shift in the continuous night-to-day SBP ratio from 0.96±0.04 to 0.91 ± 0.03 (p < 0.001), outperforming the ARB+Thiazide and BB+Thiazide arms. Treatment compliance (92%-95%) and overall adverse event rates (7.1%-9.7%) remained comparable across all groups.
Conclusions:
Dual therapies show class-dependent effects on BPV and circadian rhythm; ACEi+CCB most effectively reduces 24-hour systolic fluctuations.odifications, with the ACEi+CCB combination yielding the most pronounced reductions in 24-hour systolic fluctuations.
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Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
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