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
OBJECTIVE To perform a systematic review of the antihypertensive activity of the angiotensin II AT1 receptor antagonists ( ARB ) .
Ambulatory versus clinic blood pressure for the assessment of anti hypertensive efficacy in clinical trials: insights from the Val-Syst Study.
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
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
OBJECTIVE To perform a systematic review of the antihypertensive activity of the angiotensin II AT1 receptor antagonists ( ARB ) .