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The effect of amlodipine on ambulatory blood pressure in hypertensive patients
J F Burris1, K S Allenby, W J Mroczek
1Cardiovascular Center of Northern Virginia, Alexandria 22302.
Insights
Amlodipine effectively controls blood pressure over 24 hours in patients with essential hypertension. This 5 mg daily dose significantly reduces both daytime and nighttime blood pressure compared to placebo.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- High-risk populations like diabetics and Black individuals exhibit elevated blood pressure and heart rate, lacking normal diurnal variation, contributing to cardiovascular complications.
- Essential hypertensives, even with diurnal patterns, show higher daytime and nocturnal blood pressure than normotensives, necessitating 24-hour blood pressure control.
- Effective antihypertensive agents must provide consistent blood pressure reduction throughout a 24-hour period for maximum therapeutic benefit.
Purpose of the Study:
- To evaluate the 24-hour efficacy of amlodipine, 5 mg once daily, in managing mild-to-moderate essential hypertension.
- To assess the impact of amlodipine on blood pressure variability and control using 24-hour ambulatory monitoring.
Main Methods:
- A randomized, double-blind, placebo-controlled, single-site study involving patients with mild-to-moderate essential hypertension.
- Patients received either amlodipine (5 mg once daily) or placebo for 4 weeks after a 4-week placebo run-in period.
- 24-hour ambulatory blood pressure monitoring was conducted at the end of each 4-week phase.
Main Results:
- Amlodipine treatment resulted in significantly lower supine blood pressure (-25.1/-10.1 mm Hg) and standing blood pressure (-21.2/-9.7 mm Hg) compared to placebo 24 hours post-dose.
- Ambulatory recordings demonstrated a clear reduction in mean blood pressure over the 24-hour interval with amlodipine.
- The 24-hour postdose measurement confirmed sustained blood pressure lowering effects of amlodipine.
Conclusions:
- Amlodipine, at a 5 mg daily dosage, provides significant and sustained 24-hour blood pressure control in patients with essential hypertension.
- The study supports the use of amlodipine for achieving consistent antihypertensive effects throughout the entire day and night.
Abstract:
Certain high-risk populations, such as diabetics and blacks, have sustained elevation in blood pressure and heart rate throughout the day and night, with blunting of the usual diurnal variability pattern. This may contribute to their higher incidence of left ventricular hypertrophy (blacks) and cardiovascular complications (diabetics). Hypertensives who maintain a diurnal pattern of blood pressure variation still exhibit higher daytime and nocturnal blood pressure levels than normotensives. Thus, to achieve maximum effectiveness in treating hypertension, 24-hour control of blood pressure is necessary. Antihypertensive agents should effectively reduce blood pressure consistently throughout a 24-hour period. The objective of this study was to assess the effects of amlodipine, 5 mg once daily, on blood pressure measured by 24-hour ambulatory monitoring in a randomized, double-blind, placebo-controlled single-site study. Patients with mild-to-moderate essential hypertension were randomized to receive amlodipine (n = 11) or placebo (n = 5) in a 2:1 ratio. A 4-week single-blind placebo run-in period was followed by a 4-week double-blind phase. Ambulatory monitoring of blood pressure was carried out for 24 hours at the end of each 4-week phase. Patients receiving amlodipine had significantly lower blood pressure compared with placebo 24 hours after the last dose (supine blood pressure -25.1/-10.1 mm Hg; standing blood pressure -21.2/-9.7 mm Hg) after 4 weeks of treatment. This effect was clearly demonstrated by the 24-hour postdose measurement and the mean blood pressure over the 24-hour interval as measured by ambulatory recordings.(ABSTRACT TRUNCATED AT 250 WORDS)