Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .
Efficacy and safety of two treatment combinations of hypertension in very elderly patients.
The study compared valsartan/amlodipine combination with irbesartan/hydrochlorothiazide ( HCTZ ) combination in very elderly hypertensives . After a 4-week placebo period , 94 hypertensives , aged 75 - 89 years were r and omized to valsartan 160mg/amlodipine 5 mg or irbesartan 300mg/HCTZ 12.5 mg for 24 weeks according to a prospect i ve , parallel group study . After 4 weeks amlodipine or HCTZ was doubled in non-responders . Patients were checked every 4 weeks . At each visit clinical sitting , lying and st and ing blood pressure ( BP ) , systolic BP ( SBP ) and diastolic BP ( DBP ) were evaluated , and an electrocardiogram was performed . At the end of the placebo period and of the treatment period a non-invasive  24-h ambulatory BP monitoring  ( ABPM ) was performed and electrolytes and uric acid were evaluated . Both combinations significantly reduced ambulatory BP . In the valsartan/amlodipine group the mean reduction ( -29.9/-15.6 for 24h , -28.6/-14.5mmHg for day-time and -26.2/-17.4mmHg for night-time SBP/DBP ) was similar to that of the irbesartan/HCTZ group ( -29.6/-15.4 for 24h , -29.3/-14.9mmHg for day-time and -25.4/-16.9mmHg for night-time SBP/DBP ) . Both combinations significantly reduced clinical sitting and lying BP values with no difference between treatments . BP changes from lying to st and ing position were significantly greater in the irbesartan/HCTZ group ( -17.2/-9.1mmHg ) than in the valsartan/amlodipine group ( -10.1/-1.9mmHg , p<0.05 for SBP and p<0.01 for DBP vs. irbesartan/HCTZ ) . Potassium significantly decreased and uric acid significantly increased ( -0.4mmol/l , p<0.05 and + 0.5mg/dl , p<0.05 vs. baseline , respectively ) only in the irbesartan/HCTZ group . In conclusion , both combinations were similarly effective in reducing ambulatory and clinical BP in very elderly hypertensives . However , valsartan/amlodipine offered some advantages in terms of less pronounced BP orthostatic changes and absence of metabolic adverse effects
Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .