title: Assessment of drug effects on blood pressure and pulse pressure using clinic, home and ambulatory measurements Antihypertensive efficacy and safety of olmesartan medoxomil compared with amlodipine for mild-to-moderate hypertension Trough:peak ratio and smoothness index in the evaluation of 24-h blood pressure control in hypertension: a comparative study between valsartan/hydrochlorothiazide combination and amlodipine Efficacy of Candesartan Cilexetil Alone or in Combination With Amlodipine and Hydrochlorothiazide in Moderate-to-Severe Hypertension ABPM comparison of the antihypertensive profiles of the selective angiotensin II receptor antagonists telmisartan and losartan in patients with mild-to-moderate hypertension Effects of valsartan/ hydrochlorothiazide and amlodipine on ambulatory blood pressure and plasma norepinephrine levels in high-risk hypertensive patients Comparative effects of Irbesartan on ambulatory and office blood pressure: a substudy of ambulatory blood pressure from the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study. Sustained antihypertensive activity of telmisartan compared with valsartan Evaluation of the 24-hour blood pressure effects of eprosartan in patients with systemic hypertension. COMPARISON OF THE EFFECTS OF AMLODIPINE AND LOSARTAN ON 24-HOUR AMBULATORY BLOOD PRESSURE IN HYPERTENSIVE PATIENTS Preventing increases in early-morning blood pressure, heart rate, and the rate-pressure product with controlled onset extended release verapamil at bedtime versus enalapril, losartan, and placebo on arising. The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension. A double-blind ambulatory blood pressure monitoring study of the efficacy and tolerability of once-daily telmisartan 40 mg in comparison with losartan 50 mg in the treatment of mild-to-moderate hypertension in Taiwanese patients. Comparative efficacy of olmesartan, losartan, valsartan, and irbesartan in the control of essential hypertension. Comparison of angiotensin II receptor blockers: impact of missed doses of candesartan cilexetil and losartan in systemic hypertension. Comparison of the effects on 24-h ambulatory blood pressure of valsartan and amlodipine, alone or in combination with a low-dose diuretic, in elderly patients with isolated systolic hypertension (Val-syst Study) Administration Time–Dependent Effects of Valsartan on Ambulatory Blood Pressure in Hypertensive Subjects Telmisartan vs losartan plus hydrochlorothiazide in the treatment of mild-to-moderate essential hypertension—a randomised ABPM study Effect of telmisartan 80 mg once daily on 24-h blood pressure profile in patients with mild-to-moderate hypertension failing to respond to prior antihypertensive therapy. Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan Comparison of candesartan versus enalapril in essential hypertension. Italian Candesartan Study Group. Comparison of office and ambulatory blood pressure measurements to assess the angiotensin II receptor antagonist eprosartan. Valsartan, a new angiotensin II antagonist: antihypertensive effects over 24 hours. Differential time effect profiles of amlodipine, as compared to valsartan, revealed by ambulatory blood pressure monitoring, self blood pressure measurements and dose omission protocol. Antihypertensive effects of two fixed-dose combinations of losartan and hydrochlorothiazide versus hydrochlorothiazide monotherapy in subjects with ambulatory systolic hypertension. An ambulatory blood pressure monitoring study of the comparative antihypertensive efficacy of two angiotensin II receptor antagonists, irbesartan and valsartan The effects of amlodipine compared to losartan in patients with mild to moderately severe hypertension. Ambulatory versus clinic blood pressure for the assessment of anti hypertensive efficacy in clinical trials: insights from the Val-Syst Study. Antihypertensive efficacy of olmesartan medoxomil, a new angiotensin II receptor antagonist, as assessed by ambulatory blood pressure measurements. Comparison of valsartan and amlodipine on ambulatory and morning blood pressure in hypertensive patients. Effects of Combination Treatment with Losartan and Trandolapril on Office and Ambulatory Blood Pressures in Non-Diabetic Renal Disease: A COOPERATE-ABP Substudy A comparative trial of controlled-onset, extended-release verapamil, enalapril, and losartan on blood pressure and heart rate changes. A comparison of the efficacies and duration of action of the angiotensin II receptor blockers telmisartan and amlodipine. Comparison of candesartan with lisinopril on ambulatory blood pressure and morning surge in patients with systemic hypertension. Effect of telmisartan/hydrochlorothiazide combination versus nifedipine GITS on ambulatory blood pressure and sympathetic activation. Comparison of the antihypertensive effects of the fixed dose combination enalapril 10 mg/nitrendipine 20 mg vs losartan 50 mg/hydrochlorothiazide 12.5 mg, assessed by 24-h ambulatory blood pressure monitoring, in essential hypertensive patients Comparison of the smoothness index, the trough: peak ratio and the morning evening ratio in assessing the features of the antihypertensive drug effect Effects of telmisartan 80 mg and valsartan 160 mg on ambulatory blood pressure in patients with essential hypertension The Effect Duration of Candesartan Cilexetil Once Daily, in Comparison with Enalapril Once Daily, in Patients with Mild to Moderate Hypertension A comparison of the efficacy and duration of action of telmisartan, amlodipine and ramipril in patients with confirmed ambulatory hypertension Use of 24-Hour Ambulatory Blood Pressure Monitoring to Assess Antihypertensive Efficacy
abstract: This study investigated the differences in the effect of an angiotensin converting enzyme inhibitor ( ACEI ) compared with an angiotensin receptor blocker ( ARB ) on blood pressure ( BP ) and pulse pressure ( PP ) measured in the clinic ( CBP and CPP , respectively ) , at home ( HBP , HPP ) and with ambulatory monitoring ( ABP , APP ) . Twenty-seven hypertensive patients were r and omised to receive lisinopril ( 20 mg ) or losartan ( 50 mg ) for 5 weeks , and were subsequently crossed-over to the alternative treatment for a second 5-week period . Measurements of CBP , 24-h ABP and 5-days HBP were performed before r and omisation and at the end of each treatment period . All measurement methods showed that lisinopril was more effective than losartan in reducing BP . However , the difference between the two drugs was demonstrated with greater precision using HBP ( P<0.001 ) than 24-h ABP ( P<0.01 ) , whereas the poorest precision for demonstrating this difference was provided by CBP ( P<0.05 ) . Lisinopril was also found more effective than losartan in reducing HPP ( P=0.01 ) and 24-h APP ( P=0.03 ) whereas no such a difference was detected using measurements of CPP . It was concluded that the antihypertensive drugs may differ in their effects not only on BP , but also on PP . HBP monitoring appears to be as reliable as 24-h ABP monitoring in detecting differences in the effect of drugs on both BP and PP . Clinic measurements seem to be the least reliable method , particularly in the detection of differences in PP The antihypertensive efficacy of the angiotensin II receptor blocker olmesartan medoxomil has been shown to compare favourably with that of other antihypertensive agents . This r and omized , double-blind study compared the antihypertensive efficacy of the starting dose of olmesartan medoxomil with that of the calcium channel blocker amlodipine besylate ( amlodipine ) in subjects with mild-to-moderate hypertension . Following a 4-week , single-blind , placebo run-in period , 440 subjects aged ⩾18 years were r and omized to the starting dose of olmesartan medoxomil ( 20 mg/day ) , amlodipine ( 5 mg/day ) , or placebo for 8 weeks . Subjects were evaluated by  24-h ambulatory blood pressure monitoring ( ABPM ) and by seated cuff blood pressure ( BP ) measurements at trough . The primary end point was the change from baseline in mean 24-h diastolic blood pressure ( DBP ) by ABPM at Week 8 . Secondary end points included change from baseline in mean 24-h ambulatory systolic blood pressure ( SBP ) at 8 weeks , change from baseline in mean seated trough cuff DBP and SBP measurements , and response and control rates for DBP < 90 and < 85 mmHg . Control rates for SBP < 140 and < 130 mmHg were also calculated . Olmesartan medoxomil and amlodipine produced significantly greater reductions in ambulatory and seated DBP and SBP compared with placebo . Mean reductions in ambulatory and seated BP were similar between the two active agents ; however , in the olmesartan medoxomil group , significantly more patients achieved the SBP goal of < 130 mmHg and the DBP goal of < 85 mmHg . Both drugs were well tolerated at the recommended starting dose . Although amlodipine was associated with a higher incidence of oedema , this did not reach statistical significance . Olmesartan medoxomil is an effective antihypertensive agent , with BP-lowering efficacy at the starting dose similar to that of amlodipine , and is associated with more patients achieving the rigorous BP goals of SBP < 130 mmHg and DBP < 85 mmHg Abstract . Objective : The aim of this study was to measure the time – effect profiles of a once-daily administered valsartan/hydrochlorothiazide combination and amlodipine on blood pressure using various indices derived from 24-h ambulatory blood pressure ( BP ) monitoring . Methods : Of the 310 r and omized out patients with uncomplicated mild-to-moderate primary hypertension , 259 ( 133 on valsartan/hydrochlorothiazide , 126 on amlodipine ) were eligible for analysis . After a 2-week placebo wash-out period , the patients were r and omly allocated to treatment with either valsartan 80 mg once daily ( o.d . ) or amlodipine 5 mg o.d . for 4 weeks ; in the case of an unsatisfactory blood pressure response , the treatments could be respectively changed to the fixed combination of valsartan 80 mg plus hydrochlorothiazide 12.5 mg o.d . or amlodipine 10 mg o.d . for a further 8 weeks . The trough : peak ratio ( global and individualized approaches ) and smoothness index ( i.e. , the ratio between the average of the 24-hourly BP changes after treatment and the corresponding st and ard deviation ) were calculated from 24-h ambulatory blood pressure recordings made after the placebo period and after 4 weeks and 12 weeks of active treatment . Results : Both regimens effectively lowered systolic and diastolic ambulatory pressures after 4 weeks and 12 weeks ( all P<0.001 ) but , among the responders , the valsartan/hydrochlorothiazide combination had a greater antihypertensive effect during the night-time hours after 12 weeks ( P=0.03/0.02 ) . In the responders , the placebo-adjusted , mean trough : peak ratios were 0.76/0.74 in the valsartan/hydrochlorothiazide group ( n=111 ) and 0.66/0.62 in the amlodipine group (n=101).The corresponding global trough : peak ratios were 0.61/0.57 for the valsartan/hydrochlorothiazide combination and 0.56/0.56 for amlodipine . However , the between-group differences in individual or global trough : peak ratios were not significant . The smoothness index was slightly , but insignificantly , greater for valsartan/hydrochlorothiazide than for amlodipine in the responders and the groups as a whole . Conclusion : Valsartan/hydrochlorothiazide and amlodipine were equally effective in reducing ambulatory BP , but the valsartan/hydrochlorothiazide combination led to more homogeneous BP control during the inter-dosing interval . Trough : peak ratio and smoothness index did not reflect this finding accurately This multicenter study evaluated the efficacy of c and esartan cilexetil , an angiotensin II type 1 receptor antagonist , used alone or in combination with amlodipine or in combination with amlodipine and hydrochlorothiazide in the treatment of patients with moderate-to-severe essential hypertension . After a 2-week , single-blind , placebo run-in period , patients entered a 12-week , open-label , dose-titration period . The c and esartan cilexetil dose was increased from 8 to 16 mg once daily ; amlodipine ( 5 mg once daily ) , hydrochlorothiazide ( 25 mg once daily ) , and additional medication were also added sequentially if necessary . Patients then entered a final 4-week , parallel-group , double-blind , r and omized , placebo-controlled withdrawal period of c and esartan alone .  A total of 216 patients were recruited . After a 2-week run-in period on placebo tablets , mean sitting blood pressure ( BP ) was 175/108 mm Hg . At the end of the 12-week dose-titration/maintenance period , mean sitting BP fell to 141/88 mm Hg . In 67 patients who were r and omized to placebo and had their c and esartan withdrawn , there was a highly significant increase in mean systolic/diastolic BP ( 13/6 mm Hg ) compared with those patients who continued with c and esartan ( ANCOVA , P < 0.0001 ) . In conclusion , c and esartan cilexetil is an effective BP-lowering drug when used alone or in combination with amlodipine or amlodipine plus hydrochlorothiazide in the treatment of moderate-to-severe essential hypertension . The drug was well tolerated throughout the investigation period The antihypertensive efficacy and tolerability profiles of the selective AT1 receptor antagonists telmisartan and losartan were compared with placebo in a 6-week , multinational , multicentre , r and omised , double-blind , double-dummy , parallel-group study of 223 patients with mild-to-moderate hypertension , defined as clinic diastolic blood pressure ( DBP ) ⩾95 and ⩽114 mm Hg , clinic systolic blood pressure ( SBP ) ⩾140 and ⩽200 mm Hg , and 24-h ambulatory DBP ⩾85 mm Hg . After a 4-week single-blind placebo run-in , eligible patients were r and omised to receive telmisartan 40 mg , telmisartan 80 mg , losartan 50 mg , or placebo . Ambulatory blood pressure monitoring ( ABPM ) after 6 weeks of double-blind therapy showed that all active treatments produced significant ( P < 0.01 ) reductions from baseline in 24-h mean sbp and dbp compared with placebo . during the 18-to-24 h period after dosing , the reductions in sbp/dbp  with telmisartan 40 mg ( 10.7/6.8 mm hg ) and 80 mg ( 12.2/7.1 mm hg ) were each significantly ( P < 0.05 ) greater than those observed for losartan 50 mg ( 6.0/3.7 mm hg ) , and losartan was no better than placebo . also for the 24-h mean blood pressure  , telmisartan 40 mg and 80 mg were significantly ( P < 0.05 ) better than losartan 50 mg . compared with losartan , telmisartan 80 mg produced significantly ( P < 0.05 ) greater reductions in both sbp and dbp during all monitored periods of the 24-h period , while telmisartan 40 mg produced significantly greater reductions in sbp and dbp in the night-time period ( 10.01 pm to 5.59 am ) ( P < 0.05 ) and in dbp in the morning period ( 6.00 am to 11.59 am ) ( P < 0.05 ) . all treatments were comparably well tolerated . telmisartan 40 mg and 80 mg once daily were effective and well tolerated in the treatment of mild-to-moderate hypertension , producing sustained 24-h blood pressure control which compared favourably with losartan The efficacy and tolerability of the combination of valsartan and hydrochlorothi-azide ( HCTZ ) were compared with that of amlodipine in reducing ambulatory blood pressure and plasma norepinephrine levels in patients with mild to moderate hypertension and at least 1 cardiovascular risk factor . At the end of a 2-week washout period , 92 out patients with a sitting diastolic blood pressure ≥95 and < 110 mm Hg , associated with at least 1 additional risk factor , were r and omly assigned to receive either valsartan 160 mg and HCTZ 12.5 mg once daily ( n=46 ) or amlodipine 10 mg alone once daily ( n=46 ) for 12 weeks , according to a prospect i ve , r and omized , open-label , blinded end point , parallel-group design . At the end of the washout period and after 6 and 12 weeks of active treatment , 24-hour ambulatory blood pressure monitoring was performed , and clinical blood pressure and heart rate and plasma norepinephrine levels were assessed ( by high-performance liquid chromatography ) . Both the valsartan/HCTZ combination and amlodipine had a demonstrable antihypertensive effect , but the combination showed an antihypertensive effect significantly greater than that of amlodipine , as demonstrated by the 24-hour ( P < .001 ) , daytime ( P < .001 ) , and nighttime ambulatory blood pressure values ( P < .01 ) and by the clinical blood pressure values at trough , which were all significantly lower . Although the trough-to-peak ratios were similar in both groups , the smoothness indexes pertaining to both systolic and diastolic pressures were significantly higher ( P < .05 and P < .001 , respectively ) in patients receiving valsartan/HCTZ , suggesting the combination produces a more homogeneous antihypertensive effect . A significant increase in plasma norepinephrine levels was associated with amlodipine ( + 9 % at 6 weeks , + 15 % at 12 weeks ) but not with the valsartan/HCTZ combination . The valsartan/HCTZ combination was better tolerated than amlodipine , which was associated with a higher frequency of ankle edema . These results indicate that the combination of valsartan 160 mg and HCTZ 12.5 mg provides more sustained and homogeneous control of blood pressure than does amlodipine 10 mg in high-risk hypertensive patients , without producing reflex sympathetic activation OBJECTIVE Irbesartan was renoprotective independently of its blood pressure-lowering effect in the Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria ( IRMA2 ) study . However , blood pressure was evaluated by trough office blood pressure ( OBP ) , which may underestimate reductions in 24-h ambulatory blood pressure ( ABP ) . In the present study , we evaluated 24-h blood pressure patterns in a sub population of the IRMA2 trial . RESEARCH DESIGN AND METHODS Type 2 diabetic patients ( n = 43 ) with persistent microalbuminuria ( as determined by repeated overnight measurements of urinary albumin excretion [ UAE ] ) and hypertension who were included in the IRMA2 study at the Steno Diabetes Center were subjected to 24-h ABP ( Takeda , TM2420 ) measurements before and 2 years after r and omization to placebo ( n = 15 ) , irbesartan 150 mg daily ( Irb150 ; n = 13 ) , or irbesartan 300 mg daily ( Irb300 ; n = 15 ) . RESULTS At baseline , the placebo , Irb150 , and Irb300 groups were comparable : OBP : 157 + /- 15/89 + /- 7 , 156 + /-15/91 + /- 11 , and 159 + /- 16/90 + /- 9 mmHg ( NS ) ; 24-h ABP : 148 + /- 13/83 + /- 11 , 148 + /- 16/82 + /- 7 and 147 + /- 16/81 + /- 10 mmHg ( NS ) ; and UAE ( geometric mean with 95 % CI ) : 43 ( 32 - 57 ) , 46 ( 30 - 70 ) , and 59 ( 42 - 85 ) micro g/min ( NS ) , respectively . We found that 2 years after r and omization , OBP was significantly reduced in all three groups ( by 11/7 , 13/8 , and 13/8 mmHg in the placebo , Irb150 , and Irb300 groups , respectively ) , but that there were no significant differences among groups . Reductions in 24-h ABP were similar in the three groups ( 11/10 , 5/7 , and 7/8 mmHg , respectively ; NS ) , as were reductions in day ABP ( 11/9 , 7/7 , and 8/9 mmHg , respectively ; NS ) and night ABP ( 4/11 , 7/7 , and 3/3 mmHg , respectively ; NS ) . The reduction in UAE at the end of the study was 0 % ( -86 to 42 ) , 38 % ( -14 to 66 ) , and 73 % ( 59 to 82 ) , respectively ( overall , P < 0.01 ) . CONCLUSION Irbesartan is renoprotective independently of its beneficial effect in lowering 24-h blood pressure in patients with type 2 diabetes and persistent microalbuminuria Background Early morning blood pressure ( BP ) surge and 24 h mean BP are linked to target-organ damage and cardiovascular events . Antihypertensive agents should sustain BP control , particularly in the last 6 h of the dosing interval or if dosing is missed . The efficacies of the long half-life telmisartan compared with shorter half-life valsartan in the last 6 h of the dosing interval following active treatment and during 24 h after a missed dose were compared . Methods In two identically design ed multinational , r and omized , double-blind , forced-titration studies , hypertensive patients ( seated diastolic blood pressure ( DBP ) , 95–109 mm Hg , 24 h mean ambulatory DBP , ≥85 mm Hg ) received once-daily telmisartan ( 40–80 mg ) or valsartan ( 80–160  ) mg ) for a total of 8 weeks ; uptitration occurred after 2 weeks ' low-dose treatment . After 4 weeks ' high-dose treatment , patients were given either 1 day 's double-blind active therapy or placebo ( that is , missed dose ) . Following a further 2 weeks ' active treatment , a cross-over was performed : patients who had previously received 1 day 's placebo received active therapy and vice versa . At baseline and after the two active or missed doses , 24 h ambulatory BP monitoring was performed . Data from the studies were pooled , as prospect ively planned and analyzed using the intent-to-treat population . Results After active therapy , last 6 h mean DBP was reduced by 7.6±7.9 mm Hg with telmisartan ( n=447 ) compared with 5.8±7.8 mm Hg with valsartan ( n=430 ) ( P=0.0044 ) . Last 6 h mean systolic blood pressure ( SBP ) was reduced by 11.1 mm Hg with telmisartan compared with 9.1 mm Hg with valsartan ( P=0.0066 ) . After a missed dose , 24 h mean DBP was reduced by 7.2±6.5 mm Hg with telmisartan ( n=437 ) compared with 5.5±6.2 mm Hg with valsartan ( n=431 ) ( P=0.0004 ) . The reduction in 24 h mean SBP after a missed dose was 10.7 mm Hg with telmisartan and 8.7 mm Hg with valsartan ( P=0.0024 ) . Absence of treatment-by- study interaction indicated that pooling of studies was appropriate . All 24 hourly mean reductions in DBP and SBP were greater for telmisartan than valsartan . Both treatments were well tolerated . Conclusions Due to its longer half-life , telmisartan offers more sustained BP control , especially at the end of the dosing period and provides sustained efficacy in poorly compliant patients in the event of a missed dose with a statistical superiority compared with valsartan BACKGROUND Eprosartan is a new nonphenyl angiotensin II receptor blocker , which has been approved for the treatment of hypertension . Although the drug has a relatively short plasma half-life of 5 to 9 h , clinical studies have suggested that its antihypertensive effect persists for 24 h. METHODS We assessed both the changes in 24-h and trough blood pressure ( BP ) ( last 4 h of the ambulatory BP while the patient was awake ) of eprosartan at doses of 600 and 1,200 mg once daily in a r and omized , double-blind , placebo-controlled trial . Ambulatory BP was monitored at placebo baseline and after 8 weeks of double-blind therapy . RESULTS Two hundred patients r and omized in the study with 177 patients completing the trial . The 24-h change in BP from baseline was 0.2/0.1 + /- 1.4/1.0 mm Hg , -7.9/ -5.4 + /- 1.0 mm Hg ( P < .0001 ) , and -7.4/-5.0 + /- 0.9 mm Hg ( P < .0001 ) in the placebo , 600-mg eprosartan , and 1,200-mg eprosartan groups , respectively . Changes in trough ambulatory BP showed significant reductions of -6.3/-4.1 + /- 1.6/1.1 mm Hg and -7.7/-5.5 + /- 1.5/1.0 mm Hg for 600 mg of eprosartan and 1,200 mg of eprosartan , respectively . CONCLUSIONS These data demonstrate that eprosartan at doses of 600 or 1200 mg significantly reduced BP throughout an entire 24-h dosing period . There were no differences between the 600- and 1,200-mg dose ; thus , 600 mg once daily should be the only dose used in the treatment of hypertension with eprosartan Effects of amlodipine ( AML ) , a long-acting calcium antagonist , and losartan ( LOS ) , an angiotensin II receptor antagonist , on 24-hr blood pressure profile were compared in 15 patients with essential hypertension . After 4 weeks of placebo period , the patients were treated with AML or LOS in a r and om cross-over design for 12–16 weeks each . Either drug was given once daily at 0800 and the doses were titrated so that the office blood pressure was reduced lower than 140/90 mmHg . At the end of each period , 24-hr blood pressure was monitored . Average office blood pressure was lowered from 158 ± 2/ 98 ± 2 mmHg to 134 ± 1/87 ± 1 mmHg by AML and 134 ± 2/88 ± 1 mmHg by LOS . Average 24-hr blood pressure was also reduced from 144 ± 3/ 92 ± 2 mmHg to 131 ± 2/84 ± 2 mmHg by AML and 135 ± 3/85 ± 2 mmHg by LOS . The averaged 24-hr systolic blood pressure was significantly lower in AML than in LOS ( p < 0.05 ) . Then , the 24-hr blood pressure was analyzed for four segments ; morning ( 0530–0900 h ) , daytime ( 0930–1800 h ) , evening ( 1830–2300 h ) and night ( 2330–0500 h ) . Although the daytime blood pressure was comparable between AML and LOS , systolic blood pressure in the evening and morning hours were lower in AML than in LOS ( 133 ± 2 vs. 138 ± 3 mmHg , p < 0.01 ; 129 ± 3 vs. 134 ± 4 , p < 0.05 ) . Trough to peak ratio of antihypertensive effect on systolic blood pressure was significantly greater in AML than in LOS ( 62 ± 5 % vs. 55 ± 4 % , p < 0.05 ) . Either drug did not cause reflective increase in pulse rate over 24 hours . These results suggest that both AML and LOS are equally effective in lowering daytime blood pressure without eliciting reflex tachycardia , however , the antihypertensive effect of AML lasts longer than that of LOS . Such information seems important to achieve 24-hr blood pressure control using these drugs BACKGROUND Therapeutic agents for the treatment of hypertension may differ in their efficacy during the early-morning period , a time when both morbid and mortal cardiovascular events are increased compared with other times of the day . METHODS We studied the effects of a chronotherapeutic delivery system of verapamil ( controlled-onset extended release [COER]-24 system ) dosed at bedtime versus conventional morning administration of both enalapril and losartan on the blood pressure ( BP ) , heart rate , and the heart rate systolic BP product during the first 4 hours after awakening in a placebo-controlled , forced-titration trial . There were 357 men and women enrolled in the trial with an untreated sitting diastolic BP of 95 to 114 mm Hg and ambulatory daytime diastolic BP > or = 85 mm Hg . Patients were r and omized to either COER-verapamil hydrochloride each evening ( 240 mg titrated to 360 mg ) , enalapril each morning ( 10 mg titrated to 20 mg ) , losartan each morning ( 50 mg titrated to 100 mg ) , or placebo . Early morning assessment s of BP , heart rate , and the heart rate systolic BP product were performed by use of 24-hour ambulatory recordings after 4 weeks ( low dose ) and 8 weeks ( high dose ) of therapy . RESULTS Results were similar at weeks 4 and 8 for all treatment groups except that the magnitude of change was greater at week 8 . After 8 weeks of treatment , reductions in early morning BP by COER-verapamil were significantly greater ( -15/-10 mm Hg ) than enalapril ( -9/-7 mm Hg , P < .01 ) and losartan ( -8/-5 mm Hg , P < .001 ) . COER-verapamil also led to greater reductions in morning heart rate , the rate-pressure product , and the rate-of-rise of BP compared with the other 2 active treatment groups . Reductions in mean 24-hour BP were greater in patients treated with COER-verapamil compared with placebo and losartan , and similar to reductions in patients treated with enalapril . CONCLUSIONS Bedtime administration of an agent design ed to parallel the circadian rhythm of BP and heart rate led to significantly greater early morning hemodynamic effects compared with other conventional once-daily antihypertensive agents dosed in the morning In this study , efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension . After a 2-week , single-blind , placebo run-in period , 60 patients were r and omised to double-blind , once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks . Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases . Both telmisartan and perindopril significantly ( p < 0.0001 ) reduced clinic systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) compared with baseline values . Also , both drugs significantly ( p < 0.0001 ) reduced 24-h mean ambulatory SBP and DBP compared with baseline . Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater ( p < 0.05 ) in telmisartan-treated patients . A 24-h mean DBP of < 85 mmHg was observed in 66.6 % of the telmisartan-treated patients but in only 46.6 % of the perindopril-treated patients ( p < 0.05 ) . It is concluded that telmisartan and perindopril both produce significant reductions in clinic SBP and DBP , but the mean reduction in ambulatory DBP during the last 8 h of the dosing interval is greater in patients treated with telmisartan Ambulatory blood pressure monitoring ( ABPM ) was used to compare the efficacy and tolerability of once-daily telmisartan 40 mg and once-daily losartan 50 mg in Taiwanese patients with mild-to-moderate essential hypertension in a r and omised , double-blind , double-dummy , parallel-group study . The initial 2-week placebo run-in phase was followed by r and omisation to treatment with telmisartan 40 mg ( n = 31 ) or losartan 50 mg ( n = 30 ) for 6 weeks . The reduction in 18- to 24-h mean ( SE ) ambulatory diastolic blood pressure ( DBP ) from baseline was significantly greater with telmisartan 40 mg ( -12.1 + /- 1.6 mmHg , p = 0.036 ) than with losartan 50 mg ( -7.0 + /- 1.8 mmHg ) . The reduction in 18- to 24-h mean ( SE ) ambulatory systolic blood pressure ( SBP ) from baseline was also greater with telmisartan 40 mg ( -16.0 + /- 2.4 mmHg ) than with losartan 50 mg ( -11.8 + /- 2.7 mmHg ) , but did not achieve statistical significance . Telmisartan was well tolerated ; no serious adverse events occurred In a multicenter , r and omized , double-blind trial , the authors compared the antihypertensive efficacy of once-daily treatment with the new angiotensin II type 1 receptor blocker ( ARB ) olmesartan ( 20 mg ) with recommended starting doses of losartan ( 50 mg ) , valsartan ( 80 mg ) , and irbesartan ( 150 mg ) in 588 patients with a cuff diastolic blood pressure ( DBP ) of greater than or equal to 100 and less than or equal to 115 mm Hg and a mean daytime DBP of greater than or equal to 90 mm Hg and less than 120 mm Hg , as measured by ambulatory blood pressure monitoring .  Cuff and ambulatory blood pressures were monitored at baseline and after 8 weeks of treatment . All groups were predominantly white and approximately 62 % male , and their mean age was approximately 52 years . In all groups , mean baseline DBP and systolic blood pressure ( SBP ) were approximately 104 and 157 mm Hg , respectively . The reduction of sitting cuff DBP with olmesartan ( 11.5 mm Hg ) , the primary efficacy variable of this study , was significantly greater than with losartan , valsartan , and irbesartan ( 8.2 , 7.9 , and 9.9 mm Hg , respectively ) . Reductions of cuff SBP with the four ARBs ranged from 8.4 - 11.3 mm Hg and were not significantly different . The reduction in mean 24-hour DBP with olmesartan ( 8.5 mm Hg ) was significantly greater than reductions with losartan and valsartan ( 6.2 and 5.6 mm Hg , respectively ) and showed a trend toward significance when compared to the reduction in DBP with irbesartan ( 7.4 mm Hg ; p=0.087 ) . The reduction in mean 24-hour SBP with olmesartan ( 12.5 mm Hg ) was significantly greater than the reductions with losartan and valsartan ( 9.0 and 8.1 mm Hg , respectively ) and equivalent to the reduction with irbesartan ( 11.3 mm Hg ) . All drugs were well tolerated . The authors conclude that olmesartan , at its starting dose , is more effective than the starting doses of the other ARBs tested in reducing cuff DBP in patients with essential hypertension Blood pressure remains poorly controlled in the hypertensive population due in large part to low or unsatisfactory patient compliance . Clinical studies that incorporate an intentionally missed dose have been design ed to evaluate the impact of poor patient compliance on the effectiveness of antihypertensive medications . In these studies , ambulatory blood pressure monitoring is continued throughout the dosing interval and beyond in order to determine when systolic and diastolic blood pressure increase into the hypertensive range . In an 8-week , r and omized , double-blind , placebo-controlled trial in patients with mild-to-moderate hypertension , the antihypertensive effects of c and esartan cilexetil 16 mg were maintained after a missed dose , whereas systolic and diastolic blood pressure increased toward baseline levels after a missed dose of losartan 100 mg . C and esartan cilexetil provided a significantly greater reduction in sitting systolic ( p = 0.004 ) and diastolic blood pressure ( p = 0.008 ) than losartan when measured 48 hours after the last dose . Moreover , the homogeneity of antihypertensive effects was greater after c and esartan cilexetil than losartan based on calculation of the smoothness index from ambulatory systolic and diastolic measurements during the first 24-hour period after dosing and during the 12-hour period after the missed dose . These results demonstrate that missing or delaying a dose of c and esartan cilexetil has less impact on antihypertensive efficacy than missing or delaying a dose of losartan Objective The aim of this study was to compare the time-effect profiles of a once-daily administration of valsartan and amlodipine , each given alone or in combination with hydrochlorothiazide , in terms of ambulatory blood pressure ( BP ) and heart rate in elderly patients with isolated systolic hypertension . Methods One hundred and sixty-four elderly out patients with systolic hypertension received valsartan 80 mg ( n=79 ) or amlodipine 5 mg ( n=85 ) once daily for eight weeks , after which the patients with poorly controlled office BP were up-titrated to valsartan 160 mg or amlodipine 10 mg once daily . If their office systolic BP was still > 140 mmHg after eight weeks at these doses , 12.5 mg hydrochlorothiazide was added for a further eight weeks . The hourly BP decreases in all of the patients were calculated on the basis of 24-h ambulatory recordings made after the placebo period and at the end of active treatment . The trough/peak ratio and smoothness index were calculated in the responders . Results Both the valsartan- and amlodipine-based treatments effectively lowered mean 24-h , daytime and night-time systolic ambulatory BP ( all p<0.001 ) without any significant differences between the two regimens . Ambulatory heart rate decreased in the subjects on valsartan and slightly increased in those on amlodipine ( the differences in 24-h and daytime heart rate were significant ( p=0.008 and 0.002 respectively ) . Among the 138 responders , the valsartan-based treatment had a greater anti-hypertensive effect during the daytime hours ( p=0.02 ) , a difference that was also significant for average 24-h BP ( p=0.02 ) . The mean systolic BP trough/peak ratio was 0.56 in the patients on valsartan , and 0.77 in those on amlodipine ( NS ) . The smoothness index was respectively 1.70 and 1.58 ( NS ) . Conclusions The present results show that both the valsartan- and amlodipine-based treatments lead to a similar long-term reduction in 24-h systolic BP . However , in treatment responders , valsartan has a greater anti-hypertensive effect during the daytime Abstract —This study investigated the administration time – dependent antihypertensive efficacy of valsartan , an angiotensin II receptor blocker . We studied 90 subjects ( 30 men and 60 women ) , 49.0±14.3 ( mean±SD ) years of age with stage 1 to 2 essential hypertension ; they were r and omly assigned to receive valsartan ( 160 mg/d ) as a monotherapy either on awakening or at bedtime . Blood pressure was measured by ambulatory monitoring every 20 minutes during the day and every 30 minutes at night for 48 consecutive hours before and after 3 months of treatment . Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately calculate the diurnal and nocturnal means of blood pressure on a per-subject basis . The highly significant blood pressure reduction after 3 months of treatment with valsartan ( P < 0.001 ) was similar for both treatment times ( 17.0 and 11.3 mm Hg reduction in the 24-hour mean of systolic and diastolic blood pressure with morning administration and 14.6 and 11.4 mm Hg reduction with bedtime administration ; P > 0.174 for treatment time effect ) . Valsartan administration at bedtime as opposed to on wakening result ed in a highly significant average increase by 6 % ( P < 0.001 ) in the diurnal-nocturnal ratio of blood pressure ; this corresponded to a 73 % relative reduction in the number of nondipper patients . The findings confirm that valsartan efficiently reduces blood pressure throughout the entire 24 hours , independent of treatment time . They also suggest that time of treatment can be chosen according to the dipper status of a patient to optimize the effect of antihypertensive therapy , an issue that deserves further investigation The objective of this prospect i ve , r and omised , open-label , blinded-end point parallel-group , multicentre study was to show that telmisartan 80 mg is not inferior to a fixed-dose combination of losartan 50 mg/hydrochlorothiazide ( HCTZ ) 12.5 mg in patients with mild-to-moderate hypertension . The criterion for noninferiority was a treatment difference of ⩽3.0 mmHg in the reduction of 24-h mean ambulatory diastolic blood pressure ( DBP ) from the end of the 4-week placebo washout period to the end of the 6-week active treatment period . In the intent-to-treat analysis , the mean reduction in 24-h DBP was 8.3±6.7 mmHg among  telmisartan-treated patients ( n=332 ) and 10.3±6.3 mmHg among  losartan/HCTZ-treated patients ( n=350 ) . The mean adjusted difference in 24-h DBP between the two treatment groups was 1.9 mmHg , allowing rejection of the a priori null hypothesis of a treatment difference of > 3 mmHg . The reduction in mean 24-h systolic blood pressure was 13.2±10.2 mmHg with telmisartan and 17.1±10.3 mmHg with losartan/HCTZ . Both drugs provided effective control over the 24-h dosing interval . Analyses of morning ( 0600–1159 ) ambulatory blood pressure monitoring DBP means and trough cuff DBP confirmed the noninferiority hypothesis of the protocol for telmisartan 80 mg vs losartan 50 mg/HCTZ 12.5 mg . The reductions in office blood pressures measured at trough in patients treated with telmisartan were −16.3/−9.6 and −18.5/−11.1 mmHg in the patients treated with losartan/HCTZ ( difference −2.4/−1.2 mmHg ) . There were no differences between the side-effect profiles of the two treatments Blood pressure is not adequately controlled in almost 50 % of patients with hypertension who are in receipt of antihypertensive therapy . This multicentre , prospect i ve , open-label trial was design ed to determine whether or not once-daily telmisartan 80 mg reduced blood pressure during the last 6 h of the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive therapy . The study comprised 100 patients ( 47 males , 53 females ) who had failed to respond satisfactorily to prior treatment given for a minimum of 3 months . At screening ,  24-h ambulatory blood pressure monitoring ( ABPM )  was conducted after the patient had been treated with the currently prescribed antihypertensive medication . Following 5 weeks of telmisartan 80 mg treatment , ABPM was repeated . Telmisartan significantly reduced mean systolic blood pressure , diastolic blood pressure ( DBP ) and pulse pressure compared with previous antihypertensive therapy over each time interval ( 24-h , morning , night-time and the last 6 h of the dosing interval [ 2.00 a.m.-8.00 a.m. ] ) analysed . In addition , more than 90 % of patients responded successfully ( clinic DBP < 90 mmHg or a > 10 mmHg reduction in clinic DBP ) at the end of telmisartan treatment . In conclusion , telmisartan provides effective blood pressure control throughout the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive medication The efficacy and safety of Iosartan and valsartan were evaluated in a multicenter , double-blind , r and omized trial in patients with mild to moderate essential hypertension .  Blood pressure responses to once-daily treatment with either losartan 50 mg ( n = 93 ) or valsartan 80 mg ( n = 94 ) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring ( ABPM ) . Both drugs significantly reduced clinic sitting systolic ( SiSBP ) and diastolic blood pressure ( SiDBP ) at 2 , 4 , and 6 weeks . Maximum reductions from baseline in SiSBP and SiDBP on 24hour ABPM were also significant with the two treatments . The reduction in blood pressure was more consistent across patients in the losartan group , as indicated by a numerically smaller variability in change from baseline on all ABPM measures , which achieved significance at peak ( P = .017 ) and during the day ( P = .002 ) . In addition , the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval . The anti hypertensive response rate was 54 % with losartan and 46 % with valsartan . Three days after discontinuation of therapy , SiDBP remained below baseline in 73 % of losartan and 63 % of valsartan patients . Both agents were generally well tolerated .  Losartan , but not valsartan , significantly decreased serum uric acid an average 0.4 mg/dL at week 6 . In conclusion , once-daily losartan 50 mg and valsartan 80 mg had similar anti hypertensive effects in patients with mild to moderate essential hypertension .  Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid , suggesting potentially meaningful differences between these two A II receptor antagonists BACKGROUND The objective of this study was to compare the antihypertensive efficacy and tolerability of c and esartan cilexetil ( CC ) with that of enalapril ( E ) and placebo ( P ) in hypertensives by clinic and ambulatory blood pressure ( BP ) .  PROCEDURES The study was an Italian multicenter , r and omized , double-blind , parallel group trial including 227 mild to moderate essential hypertensives ( age range , 18 to 70 years ) . After 4 weeks of P , patients were r and omized to 8 weeks of treatment with P or CC ( 4 mg ) or E ( 10 mg ) once daily , which was eventually increased to 8 mg and 20 mg once daily in nonresponders . At the end of each study phase , trough BP was measured by conventional sphygmomanometry and ambulatory BP was monitored over 24 h by a Spacelabs device . Analysis of 24-h BP profile included calculation of 24-h , daytime , nighttime , and hourly average values . RESULTS In the 178 patients evaluable per protocol , at the end of 8 weeks of treatment , trough systolic ( S ) and diastolic ( D ) BP were similarly reduced by both active treatments ( 13 + /- 12 and 10 + /- 7 mm Hg for CC and 14 + /- 12 and 10 + /- 7 mm Hg for E ) and significantly more by both treatments than by P ( 6 + /- 11 and 7 + /- 8 mm Hg , P < .01 v CC and E ) . In the 85 patients with valid 24-h recordings reduction in 24-h BP was again similar for the two active groups . The antihypertensive effect was still evident during h 23 and 24 after the last dose for both active treatments ( 8 + /- 20 v 5 + /- 18 mm Hg for SBP and 4 + /- 12 v 6 + /- 13 mm Hg for DBP , CC v E , respectively ) but not for P. Heart rate was not significantly modified by either active treatment . The incidence of adverse events was greater in the E than in the CC group . CONCLUSIONS Our study provides evidence that CC at a dose of 4 to 8 mg is as effective as E at a dose of 10 to 20 mg over 24 h , but is better tolerated than BACKGROUND : To determine the efficacy and dose-response of the new angiotensin II receptor antagonist eprosartan , we conducted a 4-week , double-blind , r and omized , multicenter study in 114 men with essential hypertension using trough clinic and ambulatory blood pressure measurements . METHODS : Patients were included if the seated diastolic blood pressure was between 95 and 115 mmHg inclusive and 0 - 12 h diastolic blood pressure was at least 87 mmHg . The effects of twice daily eprosartan at 50 , 100 , 150 and 200 mg were compared with those of placebo . RESULTS : At trough , the clinic diastolic blood pressure was reduced significantly only by the 200 mg dose compared with placebo ( mean placebo-subtracted change -6.0 mmHg , 95 % confidence intervals -10.5 , -1.5 , P = 0.001 ) . In contrast , the 12 h mean reduction in diastolic blood pressure was significant for both the 150 mg dose ( mean change -5.3 mmHg , 95 % confidence intervals -10.2 , -0.1 , P = 0.0075 ) and the 200 mg dose ( mean change -5.5 mmHg , 95 % confidence intervals -10.3 , -0.6 , P = 0.0049 ) . Similar trends were observed for the systolic pressure and mean changes in 24 h pressures .  Eprosartan significantly reduced adjusted mean daytime ( 0 - 12 h after dose ) diastolic ambulatory pressure linearly with dose . CONCLUSION : These data demonstrate increased sensitivity of the ambulatory blood pressure over the research clinic blood pressure in evaluating the efficacy of the new antihypertensive agent eprosartan . Additionally , these findings demonstrate that higher doses of this drug will be necessary in future studies This study was done to assess the antihypertensive efficacy of once-daily valsartan 20 mg , 80 mg , 160 mg , and 320 mg over 24 hours using ambulatory blood pressure monitoring ( ABPM ) . A total of 217 adult out patients with uncomplicated essential hypertension ( office mean sitting diastolic blood pressure [ DBP ] of > or = 95 to < or = 115 mm Hg ) participated in this multicenter , double-masked , placebo-controlled study . Patients were r and omized to receive valsartan 20 mg , 80 mg , 160 mg , 320 mg , or placebo for 8 weeks . Twenty-four-hour ABPM was done at baseline and after 8 weeks of treatment . All valsartan doses produced significant decreases in average ambulatory systolic blood pressure ( SBP ) and DBP over 24 hours compared with placebo . A trend to greater reductions compared with placebo was observed for doses of valsartan 80 mg and greater ( 80 mg , -6.61 mm Hg DBP , -11.04 mm Hg SBP ; 160 mg , -5.51 mm Hg DBP , -10.61 mm Hg SBP ; 320 mg , -8.44 mm Hg DBP , -14.34 mm Hg SBP ) compared with valsartan 20 mg ( -3.52 mm Hg DBP , -5.92 mm Hg SBP ) . Valsartan produced consistent reductions compared with placebo during both day ( > 6 AM to < or = 10 PM ) and night ( > 10 PM to < or = 6 AM ) . However , in all groups , the circadian pattern of blood pressure over 24 hours was preserved and was similar to that observed at baseline ( but shifted into the normotensive range in a parallel fashion ) . The data show that single daily doses of valsartan 80 mg and greater provide effective control of both DBP and SBP over a 24-hour period without loss of diurnal variation Amlodipine and valsartan are once-daily antihypertensive agents . To date , no comparison between these agents given as monotherapies was reported . This study was aim ed to evaluate the therapeutic coverage and safety of amlodipine and valsartan in mild-to-moderate hypertensive patients . Multicenter , double-blind , r and omized , comparative study . After a 4-week placebo wash-out period , 246 out patients with office diastolic blood pressure 95 < or = DBP < or = 110 mmHg and systolic blood pressure ( SBP ) < 180 mmHg , in addition to a mean daytime SBP and /or DBP > 135/85 mmHg on 24-h ambulatory blood pressure monitoring ( ABPM ) , were r and omly allocated to once-daily amlodipine 5 - 10 mg or valsartan 40 - 80 mg , for 12 weeks . In a subgroup of patients , 48-h ABPM were performed at the end of the treatment period . Dose omission was simulated by a single-blind placebo dosing . The primary efficacy end-point was the 24-h trough office BP after 12 weeks of active therapy . The reductions in 24-h trough BP were more pronounced in amlodipine compared with valsartan group as well in office [ SBP : -17.8 + /- 10.9 vs. -14.6 + /- 11.2 , P = 0.025 , DBP : -12.7 + /- 7.2 vs. -10.9 + /- 7.8 mmHg , P = 0.06 ) as in ambulatory BP ( SBP/DBP : -13.0 + /- 13.7/-10.8 + /- 9.1 vs. -7.2 + /- 19.4/-4.9 + /- 13.4 mmHg , P < 0.05 ) . Forty-eight hours after the last active dose , the slope of the morning BP surge ( 4 - 9 h ) was less steep with amlodipine vs. valsartan [ DBP ( P < 0.04 ) , SBP ( n.s . ) ] . Ankle edema were more often reported in amlodipine group . These results suggest a superior BP lowering and a longer duration of action with amlodipine compared with valsartan BACKGROUND The efficacy of losartan ( L ) in combination with hydrochlorothiazide ( HCTZ ) has been demonstrated to reduce blood pressure . However , there are limited data on the effects of L/HCTZ combinations versus HCTZ monotherapies in reducing ambulatory systolic blood pressure . The aim of this study was to compare the effects of these treatment approaches in patients with ambulatory systolic hypertension . METHODS Patients were r and omized to receive L 50 mg ( n = 60 ) or HCTZ 12.5 mg ( n = 60 ) for 6 weeks . Patients were then force-titrated to L 50/HCTZ 12.5 mg and to L 100/HCTZ 25 mg or were sham-titrated to HCTZ 12.5 mg and force-titrated to HCTZ 25 mg , respectively . Clinic and 24-h ambulatory blood pressure ( ABP ) were measured at baseline and after each 6-week treatment period . RESULTS We found that L 50 and HCTZ 12.5 induced significant and similar decreases in clinic and ABP . The combinations of L 50/HCTZ 12.5 and L 100/HCTZ 25 provided significantly greater decreases in clinic and ABP than did HCTZ monotherapies . The L 50/HCTZ 12.5 and L 100/HCTZ 25 combinations provided significant additional decreases in systolic/diastolic ABP during daytime ( -5.3/-2.0 mm Hg ; P < .001 and -5.8/-3.4 mm Hg ; P < .001 ) and the other periods of the 24-h interval compared with the levels achieved by the previous treatment , indicating a clear dose-response relationship . However , increasing the dose of HCTZ from 12.5 mg to 25 mg was not associated with additional ABP reductions . CONCLUSIONS Combinations of L 50/HCTZ 12.5 and L 100/HCTZ 25 provided greater reductions in clinic and ABP than HCTZ monotherapies , with a clear dose-response relationship with regard to ABP . These results support the use of ABP monitoring when assessing the efficacy of antihypertensive therapies Background The primary objective of this study was to compare the change from baseline in mean diastolic ambulatory blood pressure ( ABP ) at 24 h post dose ( trough measurement ) after 8 weeks of treatment with irbesartan or valsartan in subjects with mild-to-moderate hypertension . Secondary objectives included comparing the mean changes from baseline in systolic ABP at trough ; 24-h ABP ; morning and night-time ABP ; self-measured systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) ; and office-measured SBP and DBP at trough . Design After a 3-week , single blind , placebo lead-in period , 426 subjects were r and omized to receive either irbesartan 150 mg or valsartan 80 mg for 8 weeks . Methods Ambulatory blood pressure measurements were obtained at baseline and at week 8 . Self-measured morning and evening DBP and SBP readings were obtained at home over a 7-day period at baseline and at week 8 . Office-measured seated DBP and SBP measurements were obtained at trough , at baseline , and at week 8 . Results Irbesartan demonstrated significantly greater reductions than valsartan for mean change from baseline in diastolic ABP at trough ( −6.73 versus −4.84 mmHg , respectively;P = 0.035 ) . Irbesartan produced significantly greater reductions than valsartan for mean systolic ABP at trough ( −11.62 versus −7.5 mmHg , respectively;P < 0.01 ) and for mean 24-h diastolic ABP ( −6.38 versus −4.82 mmHg , respectively;P = 0.023 ) and systolic ABP ( −10.24 versus −7.76 mmHg;P < 0.01 ) . Irbesartan also produced significantly greater reductions than valsartan for office-measured seated DBP ( −10.46 versus 7.28 mmHg , respectively;P < 0.01 ) and SBP ( −16.23 versus −9.96 mmHg , respectively;P < 0.01 ) and for self-measured morning DBP ( −6.28 versus −3.75 mmHg , respectively;P < 0.01 ) and SBP ( −10.21 versus −6.97 mmHg , respectively;P < 0.01 ) . Both drugs were well tolerated . Conclusion Irbesartan was more effective than valsartan in reducing DBP and SBP at trough and in providing greater overall 24-h blood pressure-lowering efficacy The calcium channel blocker amlodipine and angiotensin II receptor blocker losartan , with or without hydrochlorothiazide ( HCTZ ) , were compared for the treatment of mild to moderate hypertension in a multicenter , double-blind , parallel-group clinical trial . Following a 2-week placebo run-in , 440 adults ( 45 - 80 years old ) were r and omized to receive either amlodipine 5 mg once daily or losartan 50 mg once daily . Patients who failed to meet the sitting diastolic blood pressure ( BP ) reduction goal of < or=90 mm Hg after 6 weeks had their dose increased to 10 mg amlodipine or had 12.5 mg of HCTZ added to the losartan 50 mg . A total of 42.3 % of losartan and 43.6 % of amlodipine subjects achieved a diastolic BP of < or=90 mm Hg at initial dose ( low dose ) . Of those who completed treatment at the low dose , 71 % of the amlodipine- and 81 % of the losartan-treated patients met BP goal . This difference was not statistically significant . Of those who received a dosage adjustment , a significantly greater percentage of amlodipine-treated patients ( 59 % ) than losartan/HCTZ-treated patients ( 42 % ) reached BP goal at the last visit ( p=0.009 ) . Including both high- and low-dose subjects , 63.8 % of amlodipine and 55.1 % of losartan patients achieved a diastolic BP of < or=90 mm Hg at the last maintenance visit ; this difference was not significant ( p=0.07 ) . Overall , reductions in mean sitting BP from baseline to the end of treatment were significantly greater in the amlodipine group than in the losartan group for both diastolic BP ( -12.6 vs. -10.3 mm Hg ; p=0.002 ) and systolic BP ( -16.1 vs. -13.7 mm Hg ; p=0.018 ) . Additionally , the response rate was significantly greater after treatment with amlodipine than with losartan in African Americans ( 62.5 % vs. 41.4 % ; p=0.033 ) and the other mostly Hispanic patients ( 67.7 % vs. 53.5 % ; p=0.039 ) . Both treatment groups showed significant reductions from baseline in 24-hour ambulatory BP at the end of treatment , with no difference between them . Adverse events were consistent with the safety profile of each drug . It is concluded that , while both amlodipine and losartan demonstrated a significant benefit for the treatment of mild to moderate hypertension , there were greater reductions in most BP measurements following treatment with amlodipine in comparison to losartan with or without HCTZ BACKGROUND Several studies have found that measurement of blood pressure ( BP ) in the clinical setting may lead to overestimation of hypertension and may yield inaccurate assessment s of the efficacy of antihypertensive treatment . OBJECTIVE The aim of this study was to determine whether the use of clinic BP in the Valsartan and Amlodipine for the Treatment of Isolated Systolic Hypertension in the Elderly ( Val-Syst ) study accurately identified those elderly out patients with systolic hypertension who had true 24-hour elevations in BP , as well as those who required dose increases in antihypertensive therapy during follow-up . METHODS In Val-Syst , patients aged between 60 and 80 years with a clinic sitting systolic BP ( SBP ) of 160 to 220 mm Hg and a diastolic BP < 90 mm Hg after a 2-week placebo washout period were r and omized to receive valsartan 80 mg or amlodipine 5 mg once daily ( level 1 ) . In those with a trough SBP > or = 140 mm Hg after 8 weeks of double-blind treatment , doses were titrated upward to valsartan 160 mg or amlodipine 10 mg once daily ( level 2 ) . If clinic SBP was > or = 140 mm Hg after a further 8 weeks , hydrochlorothiazide 12.5 mg was added for an additional 8 weeks ( level 3 ) . Clinical decisions during the active-treatment period were based on clinic BP measurements .  Thirteen of the 35 participating centers assessed ambulatory BP as well as clinic BP at baseline and the end of the treatment , making it possible to compare the results of the 2 modes of measurement . The Student test was used to compare drug-induced changes in clinic and ambulatory BP in individual patients . Differences between the decreases in clinic and ambulatory BP at the 3 treatment levels were tested using repeated- measures analysis of covariance ( ANCOVA ) , with baseline as the covariate . RESULTS One hundred sixty-four elderly patients ( age range , 60 - 80 years ; 85 men , 79 women ) were included in the study ( 79 valsartan , 85 amlodipine ) , and valsartan and amlodipine were reported to have comparable effects on the level and rhythm of 24-hour BP In the present study , 22 of 164 patients had white-coat hypertension at baseline ( clinic SBP > or = 160 mm Hg and mean 24-hour SBP < 130 mm Hg ) . For both treatments combined , the mean ( SD ) decreases in clinic SBP were inversely proportional to the treatment level ( level 1 = -33.2 ( 7.9 ) mm Hg ; level 2 = -31.6 ( 11.8 ) mm Hg ; level 3 = -29.3 ( 11.6 ) mm Hg ; P = 0.001 , overall ANCOVA ) . In contrast , after adjusting for baseline values , the decreases in mean 24-hour SBP did not differ between treatment levels ( level 1 = -10.8 [ 10.4 ] mm Hg ; level 2 = -13.0 [ 11.2 ] mm Hg ; level 3 = -16.4 [ 13.8 ] mm Hg ) . The decrease in clinic BP during therapy was similar in patients with white-coat hypertension and sustained hypertension ( clinic SBP > or 160 mm Hg and mean 24-hour SBP > or = 130 mm Hg ) , whereas 24-hour and 8- to 9-am SBP decreased significantly only in patients with sustained hypertension ( P < 0.001 ) . At the end of the study , mean 24-hour SBP continued to be uncontrolled ( > or = 130 mm Hg ) in 16 of 53 patients ( 30.2 % ) at treatment level 1 , 27 of 62 ( 43.5 % ) at level 2 , and 19 of 49 ( 38.8 % ) at level 3 ( P = NS ) . CONCLUSION Based on the findings in this population of elderly patients with systolic hypertension , the management of hypertension may vary depending on whether decisions concerning the selection of patients for clinical trials and treatment adjustments during follow-up are made using clinic or ambulatory BP measurement Olmesartan medoxomil is a new angiotensin II receptor blocker . In this r and omized , double-blind , placebo-controlled study , the efficacy and safety of olmesartan medoxomil was assessed in 334 patients with moderate to severe essential hypertension . Patients were r and omized to receive placebo ; 5 , 20 , or 80 mg olmesartan medoxomil q.d . ; or 2.5 , 10 , or 40 mg olmesartan medoxomil b.i.d . Ambulatory and cuff blood pressure were measured prior to and after 8 weeks of treatment . Treatment with olmesartan medoxomil result ed in a significant placebo-adjusted reduction of mean 24-hour ambulatory diastolic blood pressure of 9.6 mm Hg , 12.2 mm Hg , and 10.6 mm Hg in the 5- , 20- , and 80-mg q.d . groups , respectively . Corresponding reductions in mean ambulatory systolic blood pressure were 14.5 mm Hg , 16.5 mm Hg , and 15.4 mm Hg . Similar reductions of diastolic and systolic blood pressure were seen with b.i.d . dosing . The diastolic trough-to-peak ratios of the q.d . doses of olmesartan medoxomil ranged from 57%-70 % , indicating 24-hour effectiveness . The safety profile of olmesartan medoxomil was similar to that of placebo . Olmesartan medoxomil appears to be a safe and effective once-a-day treatment for hypertension BACKGROUND Cardiovascular events occur most frequently in the morning . We aim ed to study the effects of monotherapy with the long-acting angiotensin II receptor blocker valsartan compared with the long-acting calcium antagonist amlodipine on ambulatory and morning blood pressure ( BP ) . METHODS We performed ambulatory BP monitoring before and after once-daily dose of  valsartan ( valsartan group , n = 38 ) and amlodipine ( amlodipine group , n = 38 ) therapy in 76 hypertensive patients . To achieve the target BP of < or = 140/90 mm Hg , valsartan was titrated from 40 mg/day to 160 mg/day ( mean dose 124 mg/day ) and amlodipine was titrated from 2.5 mg/day to 10 mg/day ( mean dose 6.4 mg/day ) . RESULTS Both drugs significantly reduced clinic and 24-h systolic BP ( SBP ) and diastolic BP ( DBP ) ( P < .002 ) . However , the antihypertensive effect of amlodipine was superior to that of valsartan in clinical SBP ( -26 mm Hg v -13 mm Hg , P = .001 ) and 24-h SBP ( -14 mm Hg v -7 mm Hg , P = .008 ) . In addition , morning SBP was significantly reduced by amlodipine from 156 to 142 mm Hg ( P < .001 ) but not by valsartan . Both agents reduced lowest night SBP to a similar extent ( amlodipine 121 to 112 mm Hg , P < .001 ; valsartan 123 to 114 mm Hg , P < .002 ) . Reduction in morning SBP surge ( morning SBP minus lowest night SBP ) was significantly greater in patients treated with amlodipine compared with those treated with valsartan ( -6.1 mm Hg v + 4.5 mm Hg , P < .02 ) . CONCLUSIONS Amlodipine monotherapy was more effective than valsartan monotherapy in controlling 24-h ambulatory BP and morning BP in hypertensive patients Background : In the COOPERATE trial , the combination treatment of the angiotensin-II receptor blocker losartan and the angiotensin-converting-enzyme inhibitor tr and olapril significantly retarded progression of non-diabetic kidney disease compared with each monotherapy . The benefit could be greatly attributable to the potent reduction of proteinuria , because the three treatment groups showed the same reductions of office blood pressure ( OBP ) . Ambulatory blood pressure ( ABP ) is reported to be better than OBP in predicting progression of kidney disease . Methods : Ninety-two patients enrolled in the COOPERATE trial underwent 24-hour ABP monitoring  at r and omization and at month 6 , year 1 , year 2 and year 3 on r and omized treatment . Results : Both OBP and ABP were similarly reduced among the three groups at all measurement points ( p = NS ) and throughout the whole study period ( p = NS ) . No significant correlation between the change in 24-hour ABP and the change in proteinuria was seen ( p = NS ) . A Cox-multivariable analysis showed that covariates affecting the renal outcomes ( a doubling serum-Cr level and /or end-stage renal failure ) were the change in proteinuria ( hazard ratio 0.49 , 95 % CI 0.34–0.78 , p = 0.01 ) and treatments ( 0.58 , 0.45–0.99 , 0.03 ) , but not 24-hour ABP ( 0.98 , 0.89–2.01 , 0.17 ) . Conclusion : The better renoprotective effect of the combination treatment is attributed to BP-independent mechanisms by more complete renin-angiotensin system blockade BACKGROUND The excess morning risk of myocardial infa rct ion and stroke may be attributable to the rapid rise in blood pressure ( BP ) and heart rate in the hours after awakening . The aim of this r and omized , double-blinded , placebo-controlled , multicenter study was to compare once-daily , controlled-onset , extended-release ( COER-24 ) verapamil to enalapril and losartan on BP and heart rate during the postawakening morning phase as well as throughout the 24-h period . METHODS A total of 406 patients were r and omized to an 8-week forced-titration period with one of the following : 1 ) COER-24 verapamil 240 mg/day titrated to 360 mg/day ; 2 ) enalapril 10 mg/day titrated to 20 mg/day , 3 ) losartan 50 mg/day titrated to 100 mg/day , or 4 ) placebo .  Office BP and heart rate and ambulatory 24-h BP monitoring was performed at baseline , 4 weeks , and 8 weeks . RESULTS Each active treatment , as compared with placebo , lowered BP both during the morning hours as well as the entire 24-h period . COER-24 verapamil was more effective in lowering morning systolic ( -16.6 mm Hg ) and diastolic ( -11.9 mm Hg ) BP than either enalapril or losartan ( P < .001 ) . For the entire 24-h period , the effects of COER-24 verapamil ( -11.6/-8.4 mm Hg ) were comparable to enalapril ( - 13.4/-8.3 mm Hg ; P = NS ) . Losartan achieved a similar 24-h effect on systolic pressure ( -9.3 mm Hg ) but was less effective on diastolic pressure ( -5.4 mm Hg ; P = .004 v COER-verapamil ) . Unlike losartan or enalapril , COER-24 verapamil was the only treatment to lower the heart rate over both the 24-h period ( -4.6 beats/min ; P < .001 ) and during waking hours ( -4.6 beats/min ; P < .001 ) . A blunted rate of rise in BP , heart rate , and rate-pressure product occurred during the postawakening period with COER-verapamil ( P = .03 ) but not with either of the other treatment arms . Lastly , the decline in BP at night was similar for COER-verapamil and losartan and greater with enalapril ( P = .014 ) CONCLUSIONS COER-24 verapamil produces changes in BP and pulse that more closely match the normal circadian hemodynamic rhythms than either do enalapril or losartan OBJECTIVES : To compare the antihypertensive effects and duration of action of the angiotensin II receptor antagonist , telmisartan , amlodipine , and placebo in patients with mild-to-moderate hypertension using both conventional clinic blood pressures and ambulatory blood pressure monitoring ( ABPM ) . METHODS : After a 4-week single-blind , placebo run-in period , qualifying patients were r and omly allocated in double-blind manner to be administered 40 mg telmisartan ( n = 73 ; increased to 80 and 120 mg as necessary for patients whose diastolic blood pressure ( DBP ) remained > 90 mmHg ) ; 5 mg amlodipine ( n = 78 ; titrated to 5 mg and titrated to 10 mg for patients whose DBP remained > 90 mmHg ) ; or placebo ( n = 81 ) . ABPM was performed at the end of the baseline period and again at the end of 12 weeks of double-blind treatment . RESULTS : Telmisartan and amlodipine treatments significantly decreased trough supine systolic blood pressure and DBP ( P < 0.001 , measured conventionally ) to a similar extent ( by 13.1/7.1 and 14.0/7.1 mmHg , respectively , at the end of 12 weeks ' treatment ) compared with placebo . Both drugs also significantly reduced 24 h mean systolic blood pressures and DBP compared with placebo ( P < 0.0001 ) , measured using ABPM , maintaining control of blood pressure throughout the dosing period . Reductions in DBP with telmisartan were greater ( P < 0.05 ) than those with amlodipine during the night-time interval and the last 4 h of the dosing period . Twenty-four-hour mean ABPM DBP < 85 mmHg were observed in 71 % of telmisartan patients and in 55 % of patients administered amlodipine . In addition , heart rates in patients treated with telmisartan were lower than heart rates in those treated with amlodipine during the final 4 h of the dosing period ( P = 0.0003 ) and during the morning interval ( P = 0.005 ) . Generally , both telmisartan and amlodipine were well tolerated , however , drug-related edema occurred significantly more commonly ( P < 0.05 ) among the patients administered amlodipine than it did among patients administered either telmisartan or placebo . CONCLUSIONS : Clinic blood pressure measurements detected no difference between the antihypertensive effects and duration s of action of telmisartan and amlodipine , both agents producing statistically significant reductions compared with placebo . ABPM measurements , however , revealed differences between the efficacies at specific time points within the dosing periods . These findings highlight the potential importance of the use of ABPM for evaluating and comparing efficacies of antihypertensive agents We performed a prospect i ve crossover study in 73 essential hypertensives to compare the effects of c and esartan and lisinopril on ambulatory blood pressure ( BP ) and early-morning BP . Twenty-four-hour ambulatory BP monitoring was performed at baseline and for each active treatment . Small doses of thiazide diuretic were added as needed . The effects of both drugs on 24-hour BP were almost identical and satisfactory . When we classified patients into the morning surge group ( the highest quartile of morning systolic BP surge > 36 mm Hg ) and the non-morning surge group ( the remaining 3 quartiles of morning BP surge ) , c and esartan was superior in decreasing morning BP and morning BP surge BACKGROUND This study compares the effects of telmisartan hydrochlorothiazide ( HCTZ ) combination versus nifedipine GITS on ambulatory blood pressure ( BP ) and sympathetic activity , in patients with mild-to-moderate hypertension . METHODS One hundred twenty-four out patients with sitting diastolic BP > or = 95 mmHg and < 110 mm Hg were r and omized to telmisartan 80 mg/HCTZ 12.5 mg daily ( n = 62 ) or nifedipine GITS 60 mg daily ( n = 62 ) for 12 weeks , according to a prospect i ve , open-label , blind end point , parallel-group design . At the end of a 2-week washout period and after 12 weeks of active treatment , 24-h noninvasive ambulatory BP monitoring  ( ABPM ) was performed , clinic BP and heart rate were measured , and plasma norepinephrine and cardiovascular responses to mental stress induced by the color word test were assessed . RESULTS Both treatments reduced ambulatory and clinic BP . However , the drug combination had an antihypertensive efficacy significantly greater than nifedipine GITS , as shown by the 24-h ( P < .001 ) , daytime ( P < .001 ) , and night-time ( P < .01 ) ambulatory BP monitoring values , as well as by the clinic BP at trough ( P < .05 ) . The trough-to-peak ratio was similar , but the smoothness index was significantly higher with the combination for both systolic and diastolic BP ( P < .05 ) . A significant increase in plasma norepinephrine levels in resting conditions was observed with nifedipine GITS ( + 20 % ) but not with telmisartan/HCTZ combination . The color word test produced a greater increase in plasma norepinephrine and heart rate values in the patients treated with nifedipine GITS than in those treated with the combination . CONCLUSIONS These results suggest that the telmisartan 80 mg/HCTZ 12.5 mg combination provided a more sustained and homogeneous BP control than nifedipine GITS 60 mg , without producing sympathetic activation Fixed combinations of calcium channel blockers and angiotensin converting enzyme inhibitors represent an alternative to diuretic-based combination therapy . The aim of the present study was to compare the antihypertensive efficacy of the combination enalapril 10 mg/nitrendipine 20 mg ( E/N ) vs losartan 50 mg/hydrochlorothiazide 12.5 mg ( L/H ) , assessed by 24-h ambulatory blood pressure monitoring . This multicentre , double-blind , parallel study included 97 hypertensive patients ( office diastolic blood pressure ( DBP ) 90–109 mmHg and daytime DBP > 85 mmHg ) . After a 2- to 3-week period of single-blind placebo , they were r and omized to receive double-blind treatment with E/N ( n=48 ) or L/H ( n=49 ) for a 4-week period . The primary outcome measure was the difference in 24-h DBP reduction between treatments from r and omization to the end of the double-blind period . Secondary efficacy variables included differences in 24-h systolic ( S ) BP reduction , daytime , night-time and office SBP and DBP reduction , proportion of responders and controlled patients , trough-to-peak ratio and smoothness indexes . Safety was assessed by the proportion of patients with adverse events and the detection of laboratory abnormalities . No significant differences were observed in the primary outcome measure . The group receiving E/N tended to show greater reductions in most measures ( 24 h , daytime and office SBP and DBP ) and higher BP control rates , but only the difference in the rate of office SBP control ( < 140 mmHg ) reached statistical significance ( 42.2 vs 22.4 % ; P=0.048 ) . The trough-to-peak ratios and smoothness indexes were similar in both groups . The incidence of adverse events related to the treatment was 27.1 % ( 95 % CI 14.5–39.6 % ) in E/N-treated patients and 14.3 % ( 95 % CI 4.5–45.8 % ) in the L/H group , but differences were not significant . The kind of event more frequently observed were flushing and headache in E/N , and dizziness and asthenia in L/H ; all observed adverse events were mild . We conclude that E/N and L/H have a similar antihypertensive efficacy , assessed by office or ambulatory blood pressure monitoring . E/N achieved a significantly higher office SBP control rate , but this was accompanied by an apparently higher proportion of mild adverse events Objective To provide a direct comparison of the trough : peak ratio ( TPR ) , the morning : evening home blood pressure ratio ( MER ) and the smoothness index ( SI ) in assessing the features of the antihypertensive drug effect . Patients and methods A total of 27 untreated hypertensives were r and omized to receive lisinopril 20 mg o.d . or losartan 50 mg o.d . for 5 weeks and were subsequently crossed-over to the alternative treatment for a second 5-week period . Twenty-four hour ambulatory and 5-day home blood pressure were monitored before r and omization and at the end of each treatment period . TPR , MER and SI were calculated for each drug for the total study population and for responders only . Results When all patients were considered , lisinopril provided higher values of TPR [ 0.63/0.66 for systolic/diastolic blood pressure ( SBP/DBP ) ] , MER ( 1.02/0.77 ) and SI ( 1.01/0.87 ) than losartan ( 0.35/0.51 , 0.60/0.60 and 0.64/0.53 , respectively ) . Analysis of responders only , again showed a clear advantage of lisinopril over losartan in TPR ( 0.77/0.67 versus 0.44/0.47 , respectively ) and MER ( 0.86/0.87 versus 0.48/0.61 ) , whereas there was no difference in SI ( 1.25/1.13 for lisinopril versus 1.11/1.12 for losartan ) . Conclusions These data suggest that the assessment of the duration of the antihypertensive drug effect provided by the MER is consistent to that by the TPR and that two drugs with different levels of TPR and MER may have the same level of SI . It appears that the SI is not simply a more reliable index of the features of the antihypertensive drug effect , but offers a different type of information complementary to that provided by the TPR and the MER , in regard to the homogeneity and the magnitude but not the duration of the antihypertensive effect Objectives This trial investigated and compared the antihypertensive efficacy of telmisartan and valsartan , two angiotensin II receptor blockers , used in monotherapy at their maximum recommended dose in hypertensive patients . Methods We studied 70 subjects ( 32 men and 38 women ) aged 47.6 ± 12.2 ( mean ± SD ) years , with mild to moderate essential hypertension ; they were r and omly assigned to receive monotherapy with either telmisartan ( 80 mg ) or valsartan ( 160 mg ) , in the form of a single daily tablet upon awakening . Blood pressure was measured by ambulatory monitoring every 20 min during the day and every 30 min at night for 48 consecutive hours before and after 3 months of treatment . Physical activity was simultaneously monitored every minute by wrist actigraphy to calculate accurately the diurnal and nocturnal means of blood pressure on a per subject basis . Results There was a highly significant blood pressure reduction during the 24 h with both drugs . The blood pressure reduction in the 24-h mean was significantly larger for valsartan 160 mg ( 18.6 and 12.1 mmHg for systolic and diastolic blood pressure , respectively ) than for telmisartan 80 mg ( 10.8 and 8.4 mmHg ; P < 0.001 between treatment-groups ) . There was also a highly significant reduction ( P < 0.001 ) of 6.5 mmHg in the 24-h mean of pulse pressure  after valsartan administration only . The trough : peak ratio and the smoothness index were slightly higher in systolic , but similar in diastolic blood pressure , for telmisartan as compared to valsartan . Conclusions Despite a shorter half-life , 160 mg/day valsartan was more effective in lowering blood pressure over 24 h than 80 mg/day telmisartan . Furthermore , valsartan was also more effective in lowering arterial pulse pressure , an observation that may have important therapeutic implication s , given the mounting evidence that pulse pressure may be a risk factor for future cardiovascular events Objective : To determine the antihypertensive efficacy , effect duration and safety of the angiotensin II type1 receptor blocker c and esartan cilexetil and the angiotensin converting enzyme inhibitor enalapril once daily in patients with mild to moderate hypertension . Methods : A multicenter , r and omised , double-blind parallel group study was performed in Finl and , France , the Netherl and s , Spain and Sweden . Three-hundred- and -ninety-five men and women in the age range 20 - 80 years with primary hypertension were r and omised to an 8-week double-blind treatment period with either c and esartan cilexetil 8 - 16 mg or enalapril 10 - 20 mg once daily , with forced dose titration after 4 weeks . Non-invasive ambulatory blood pressure was measured for 36 h at baseline and after 8 weeks . The primary efficacy variable was the change in mean diastolic and systolic ambulatory blood pressure 22 - 24 h post-dose . Results : There was a significant difference in the adjusted mean difference for the change from baseline to week 8 between c and esartan cilexetil and enalapril 22 - 24 h post-dose by -3.5 mmHg ( 95 % confidence interval , CI : -6.8 to -0.3 mmHg ; p < 0.032 ) in ambulatory systolic blood pressure and -3.0 mmHg ( 95 % CI : -5.1 to -0.8 mmHg ; p < 0.008 ) in ambulatory diastolic blood pressure . There was a significant difference in adjusted mean daytime ambulatory blood pressure 24 - 36 h post-dose by -4.2 mmHg ( 95 % CI : -6.8 to -1.6 mmHg ; p < 0.002)/-3.5 mmHg ( 95 % CI : -5.1 to -1.8 mmHg ; p < 0.001 ) . Both drugs were generally well tolerated . Conclusion : The results of the present study suggest that advantages may be attributed to the use of c and esartan cilexetil , as compared to enalapril in the treatment of patients with essential hypertension . In comparison with enalapril 20 mg , c and esartan cilexetil 16 mg more effectively lowered blood pressure at trough and in particular on the day following the day after the last dose Objectives The aim of the study was to compare the antihypertensive effects and the duration of action of telmisartan , amlodipine and ramipril in patients with mild-to-moderate hypertension using ambulatory blood pressure ( ABP ) monitoring . Methods After a 2–4-week single-blind , placebo run-in period , qualifying patients were r and omized to receive telmisartan 80 mg ( n=18 ) ; amlodipine 5 mg ( n=22 ) ; titrated to 10 mg after 4 weeks ; or ramipril 2.5 mg ( n=17 ) ; titrated to 5 mg and 10 mg after 1 and 3 weeks , respectively , administered once daily in the morning ( 0700 h ) . Ambulatory blood pressure monitoring was performed at baseline and at the end of the 8-week treatment period . Plasma renin activity was measured over 24 h at the same time points . Results Telmisartan and amlodipine provided significant reductions from baseline ( P<0.0001 ) and not statistically different reductions between treatments in ABP during daytime ( 9.3/6.0 and 14.7/9.4 mmHg , respectively ) and night-time ( 12.4/7.7 and 13.3/8.6 mmHg , respectively ) at the end of 8 weeks ' treatment . In contrast , although ramipril provided significant reductions in ambulatory systolic and diastolic BP from 2–6 h post dose ( peak effect ) , it failed to induce significant reductions in mean daytime ( 4.5/1.6 mmHg ) and night-time ( 1.8/0.1 mmHg ) ambulatory BP . In addition , the greater reductions in ABP with telmisartan and amlodipine were associated with a significant rise in plasma renin activity whereas ramipril only increased renin during the first 4 h of the administration interval . Conclusion The results of the present study confirm the efficacy of both telmisartan and amlodipine in reducing ABP during each period of the 24-h interval . Because ABP reduction with ramipril was restricted to its peak effect , the present data do not support the use of this agent when administered once daily in the morning Abstract Introduction : Goal rates , the percentage of patients with hypertension achieving recommended SBP/DBP , are a clinical ly important assessment of an antihypertensive agent ’ efficacy . Twenty-four-hour ambulatory blood pressure monitoring ( ABPM ) allows accurate assessment of a patient ’s hypertension and risk for cardiovascular events , and provides the most accurate measure of an antihypertensive agent ’s efficacy throughout a 24-hour dosing interval . Methods : A 12-week ( 4-week single-blind placebo run-in phase followed by an 8-week double-blind active treatment phase ) r and omized , parallel-group study reported that the recommended starting dose of the angiotensin II receptor antagonist ( angiotensin receptor blocker ; ARB ) olmesartan medoxomil ( Benicar ™ ) 20 mg/day was more effective than starting doses of losartan potassium ( Cozaar ® ) 50 mg/day , valsartan ( Diovan ® ) 80 mg/day , or irbesartan ( Avapro ® ) 150 mg/day in reducing cuff DBP in patients with essential hypertension . The present report includes analyses of secondary efficacy variables from this 12-week trial . Results : The mean reduction in blood pressure from baseline to week 8 ( end of treatment ) was significantly greater with olmesartan medoxomil than with valsartan for all ABPM times analyzed ( 24 hours , daytime , night-time , and last 2 and 4 hours of monitoring ) . Statistical significance was reached for comparisons of oimesartan medoxomil with losartan potassium for a majority of times analyzed and with irbesartan for SBP in the last 4 hours of monitoring . Goal rates for accepted critical ambulatory blood pressure ( ABP ) values of < 130/80 mm Hg for mean 24-hour ABP , < 135/85 mm Hg for mean daytime ABP , and < 120/75 mm Hg for mean night-time ABP were significantly greater for patients receiving olmesartan medoxomil than for those receiving losartan potassium or valsartan . Goal rates were numerically superior , but not statistically significant , to those achieved with irbesartan . Compared with losartan potassium or valsartan recipients , a significantly higher percentage of patients treated with olmesartan medoxomil achieved the 24-hour ABP goal of < 130/85 mm Hg . The last 2 and 4 hours of ABPM indicated that olmesartan medoxomil maintained larger mean decreases in blood pressure through the morning surge . Discussion / Conclusion : ABP goal rates are a meaningful measure of antihypertensive efficacy . The effects on mean change from baseline in ABP and ABP goal rates after 8 weeks of treatment were numerically better , but not statistically significant , for olmesartan medoxomil than for irbesartan . However , olmesartan medoxomil was significantly more effective than losartan potassium or valsartan
target: RESULTS The global antihypertensive activity of ARB differs from that observed with amlodipine in the sense that the magnitude of the reduction in the BP values does not essentially depend on the initial BP values nor on the dose used .
  When only ARB were considered , the drug used was a determinant for systolic BP reduction , whereas for diastolic BP the influence was on the BP reduction and the duration of the antihypertensive activity .
  The dose used had a particular influence on the duration of the antihypertensive activity for both systolic and diastolic BP .
  CONCLUSION Among the ARB , the influence is on duration more than on the magnitude of BP reduction .
  Dose , therefore , is an important factor in the duration of antihypertensive activity
background: OBJECTIVE To perform a systematic review of the antihypertensive activity of the angiotensin II AT1 receptor antagonists ( ARB ) .