The data do not suggest that any one ACE inhibitor is better or worse at lowering BP .
ACE inhibitor doses above Max did not significantly lower BP more than Max .
There are no clinical ly meaningful BP lowering differences between different ACE inhibitors .
BACKGROUND ACE inhibitors are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure ( BP ) , heart rate and withdrawals due to adverse effects ( WDAE ) .
OBJECTIVES To quantify the dose-related systolic and /or diastolic BP lowering efficacy of ACE inhibitors versus placebo in the treatment of primary hypertension .
Superiority of home blood pressure measurements over office measurements for testing antihypertensive drugs.
OBJECTIVE : To compare the effects on office blood pressure and home blood pressure of placebo and active drug administration . DESIGN : After a 2-week wash-out period , patients with mild-to-moderate hypertension entered a 2-week single-blind placebo period and then a 4-week double-blind period . Patients were r and omly assigned to be administered either 2 mg tr and olapril once daily or its placebo in a 2:1 proportion . Office blood pressure was measured by a physician at the end of each period , using a mercury sphygmomanometer ( mean of three consecutive measurements ) . Home blood pressure was measured during the last week of each period according to st and ard procedure carefully taught to each patient by the physician . Compliance was checked by using electronic pill boxes . RESULTS : Data for 34 of the 44 patients who entered the study were eligible for analysis .  Baseline systolic blood pressure/diastolic blood pressure were significantly ( P = 0.0001/P = 0.0001 ) higher for office blood pressure ( 161/101 mmHg ) than they were for home blood pressure ( 145/93 mmHg ) . There was no statistically significant difference between the placebo and active-treatment groups at baseline . During the single-blind period , blood pressures measured at the office and at home did not change significantly . Office blood pressure decreased by 2.7 + /- 10 mmHg for systolic blood pressure and by 0.5 + /- 4 mmHg for diastolic blood pressure whereas home blood pressure increased by 0.8 + /- 6 mmHg for systolic blood pressure and by 0.7 + /- 4 mmHg for diastolic blood pressure . During the double-blind period , office blood pressure fell significantly with tr and olapril treatment ( systolic by 10.2 + /- 12 mmHg , diastolic by 8.3 + /- 6 mmHg ; P = 0.0005/0.0001 , versus single-blind placebo period ) but this decrease was not significantly different ( P = 0.45/0.92 ) from the fall in members of the placebo group ( systolic by 6.9 + /- 9 mmHg , diastolic by 8.0 + /-6 mmHg ; P = 0.04/0.002 , versus single-blind placebo period ) . Thus , no antihypertensive effect of tr and olapril was demonstrated . The fall lin home blood pressure with tr and olapril treatment was significant ( systolic by 10.7 + /- 8 mmHg , diastolic by 5.8 + /- 5 mmHg ; both P = 0.0001 , versus single-blind placebo period ) and was significantly greater ( P = 0.0004/0.004 ) than the minimal change observed with placebo ( systolic fell by 0.2 + /- 5mmHg , diastolic fell by 0.6 + /- 4 mmHg ; P = 0.90/0.62 , respectively , versus single-blind placebo period ) . The evening decrease in home blood pressure was similar to the morning decrease in home blood pressure in members of the tr and olapril-treated group . The result ing morning : evening decrease in blood pressure ratio was 0.83 for diastolic blood pressure and 0.95 for systolic blood pressure . For the subgroup of responders , mean of individual ratios was 0.77 + /- 0.43 for diastolic blood pressure and 0.70 + /- 0.39 for systolic blood pressure . CONCLUSION : The placebo effect observed with office blood pressure measurements does not occur with home blood pressure measurements . Expected treatment effect can alter a physician 's blood pressure readings . The precision of measurements is greater with home blood pressure ( there is a lower SD ) . Use of home blood pressure measurements increases the power of comparative trials , allowing one either to study fewer subjects or to detect a smaller difference in blood pressure
The data do not suggest that any one ACE inhibitor is better or worse at lowering BP .
ACE inhibitor doses above Max did not significantly lower BP more than Max .
There are no clinical ly meaningful BP lowering differences between different ACE inhibitors .
BACKGROUND ACE inhibitors are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure ( BP ) , heart rate and withdrawals due to adverse effects ( WDAE ) .
OBJECTIVES To quantify the dose-related systolic and /or diastolic BP lowering efficacy of ACE inhibitors versus placebo in the treatment of primary hypertension .