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 .
Reduction of ACE activity is insufficient to decrease microalbuminuria in normotensive patients with type 1 diabetes.
OBJECTIVE To study whether administration of 1.25 and 5.0 mg ramipril daily , compared with placebo treatment , reduces the urinary albumin excretion rate ( UAER ) in normotensive patients with type 1 diabetes . RESEARCH DESIGN AND METHODS Ramipril was administered double blind at two different doses ( 1.25 [ n = 19 ] and 5.0 mg [ n = 18 ] ) , and compared with placebo ( n = 18 ) after a single-blind placebo period of 1 - 4 weeks . The patients ( total , n = 55 ; women , n = 14 ) were followed for 2 years . To document an effect on the renin-angiotensin system , ACE activity and plasma-renin activity ( PRA ) were measured . In addition , 24-h ambulatory blood pressure ( BP ) was recorded at baseline and repeated after 1 and 2 years using a Spacelab 90207 ambulatory BP recording device ( Spacelab , Redmont , CA ) . RESULTS Both doses of ramipril were sufficient to reduce ACE activity and to increase PRA significantly as compared with placebo ( P < 0.05 for both ) . On the other h and , neither ambulatory nor clinic BP was affected by either dose of ramipril compared with the placebo group . There was no progression of UAER in the placebo group during the 2 years of the study . Analysis of covariance showed no differences in UAER between the three treatment groups at year 1 ( P = 0.94 ) or year 2 ( P = 0.97 ) , after adjusting for baseline . Furthermore , there were no statistically significant changes from baseline UAER within any of the three treatment groups . CONCLUSIONS Treatment with ramipril did not affect microalbuminuria or clinic or ambulatory BP in this study . On the basis of the present study , we question the clinical use of ACE inhibitors in stably normotensive patients with type 1 diabetes and microalbuminuria in whom a concomitant reduction in BP is not demonstrated
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 .