Comparison of circadian blood pressure profile in Stage 2-3 arterial hypertension patients receiving different antihypertensive combinations

Abstract

Aim: To compare the dynamics of various parameters of circadian blood pressure profile (BP CP) and to assess the selection criteria for two combinations of the first-choice antihypertensive agents (AHA): angiotensin-converting enzyme (ACE) inhibitor plus thiazide diuretic (TD) or angiotensin II receptor antagonist (ARA) and calcium antagonist (CA) in patients with moderate to severe arterial hypertension (AH). Material and methods: This randomised study included 66 men aged 35-60 years with Stage 2-3 AH. Group I (n=37) received the combination of enalapril and hydrochlorothiazide (ENP + HCT; 20/12,5 mg/d), while Group II (n=29) was administered the combination of valsartan and S-amlodipine (VAL + S-AMD; 160/5 mg/d). All medications were taken daily, once a day. At baseline and after 12 weeks of the treatment, all participants underwent 24-hour blood pressure monitoring (BPM). The analysed parameters included: mean values and variability of systolic and diastolic BP (SBP, DBP), time index and pressure load index for SBP and DBP over 24 hours, dayand night-time, magnitude and velocity of SBP and DBP morning surge (MS), and diurnal/nocturnal BP ratio. Results: Twelve-week therapy with combinations significantly reduced mean SBP and DBP levels in patients with moderate to severe AH, regardless of the time of the day/night. It was also associated with reduced BP variability, mostly during the day-time. The ENP+HCT combination was more effective in terms of SBP MS reduction, while the VAL+S-AMD combination effect was more pronounced for DBP MS prevention. The VAL+S-AMD combination significantly improved diurnal/nocturnal BP ratio. Conclusion: The results obtained should be considered in the design of the antihypertensive combination therapy for Stage 2-3 AH patients with "non-dipper", "night-peaker", and "over-dipper" types of the two-phase BP CP.