Anderson A, Morgan TO
ACE inhibitors given at night give better control of
early morning blood pressure
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:141A 1996
There is much interest recently in chronotherapeutics. This interest
is driven by awareness of the circadian patterns of disease activity.
In this regard, it has been observed that many cardiovascular
complications tend to occur with increased frequency in the morning.
Because blood pressure and heart rate increase at this time of the
day, interest is growing in the effects of drug timing on this early
morning rise in blood pressure.
These authors compared the effects of perindopril 4 mg given
at 9 am or 9 pm in 22 essential hypertensive subjects using a
randomized cross-over study design. Clinic blood pressure was measured
between 7 am and 9 am and ambulatory blood pressure was also
monitored. Although clinic, 24-hour, daytime and nighttime blood
pressure averages were similar, the peak morning blood pressure was
reduced more by the evening dose of perindopril. Similar results were
obtained in a second study in 12 hypertensive subjects dosed with
enalapril.
Comment: These findings are not unique since previous
work with accupril has been published showing that nighttime dosing
lowers nighttime blood pressure better than morning dosing. Also, work
has been published with a special formulation of verapamil taken at
night showing a marked blunting of the early morning rise in blood
pressure. Whether such reductions in early morning hemodynamic
parameters translate into reduction of cardiovascular events is yet to
be seen. George Mansoor, M.D., University of Connecticut
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11th Scientific Meeting, American Society of Hypertension
H: Drug therapy :
ACE inhibitors
H: Drug therapy :
Monotherapy