Assessing duration of antihypertensive effects with whole-day blood pressure monitoring

Abstract

The whole-day blood pressure response to once-daily and twice-daily administration of a combination of captopril and hydrochlorothiazide was measured in a study of elderly patients (aged 59 to 78 years) with mild to moderate hypertension. Whole-day automated ambulatory blood pressure profiles were obtained at baseline, after 8 weeks of therapy with a combination of 25 mg of captopril and 15 mg of hydrochlorothiazide twice daily, and again after 8 weeks of once-daily therapy with 50 mg of captopril and 25 mg of hydrochlorothiazide. Average systolic and diastolic whole-day blood pressures significantly decreased from baseline during both twice-daily treatment (mean +/- SEM change, 18 [+/- 3]/10 [+/- 2] mm Hg) and once-daily treatment (11 [+/- 2]/9 [+/- 1] mm Hg). While the decrease in systolic blood pressure during once-daily therapy was less than that during twice-daily therapy for the group as a whole, 16 of 19 patients achieved normal systolic (less than 140 mm Hg) and diastolic (less than 90 mm Hg) blood pressures throughout the day during the once-daily regimen. During once-daily therapy, the blood pressure reductions were sustained throughout the 24-hour period, and were not attenuated during the final 2 to 4 hours before the next dose. A subgroup of 5 patients were identified who appeared unresponsive to both twice-daily and once-daily antihypertensive treatment. Despite hypertensive office-measured blood pressures at entry to the study, 4 of these 5 patients actually had normotensive whole-day blood pressure averages at baseline (mean, 131 [+/- 7]/81 [+/- 4] mm Hg). Thus, whole-day ambulatory blood pressure monitoring is a valuable tool for testing treatment responses. It demonstrated that once-daily treatment with low doses of captopril and hydrochlorothiazide was as effective as twice-daily administration in decreasing diastolic pressures throughout the day, but was slightly less effective in decreasing systolic pressures. Additionally, the monitoring identified apparently normotensive patients in whom treatment may not be indicated.