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 .
Long‐term efficacy of a new, fixed, very‐low‐dose angiotensin‐converting enzyme‐inhibitor/diuretic combination as first‐line therapy in elderly hypertensive patients
Objective To determine the long-term efficacy and safety of a fixed , very-low-dose tablet combining one-half the st and ard dose of perindopril with one-quarter the st and ard dose of indapamide as first-line treatment in elderly patients . Design Double-blind , r and omized , placebo-controlled study in an outpatient setting . Patients and interventions Following a single-blind , placebo run-in period of 4 weeks , patients [ 65–85 years , with mild-to-moderate essential hypertension or isolated systolic hypertension ( ISH ) ] were r and omized to receive one tablet of perindopril 2 mg/indapamide 0.625 mg ( Per/ Ind ) ( n = 193 ) or placebo ( n = 190 ) , daily for 12 weeks . After this first 12-week period , all patients on Per/Ind ( n = 138 ) and patients responding to placebo ( n = 61 ) were maintained on their previous regimen for a further 48 weeks . Patients in the placebo group whose blood pressure was not normalized , were switched to Per/Ind ( n = 60 ) . Main outcome measure The primary endpoint was the proportion of patients with blood pressure that normalized between weeks 0 and 60 . Results After 1 year of treatment ( intention-to-treat ) supine systolic and diastolic blood pressure decreased by 23.0 ± 15.3 mmHg and 13.3 ± 9.4 mmHg with Per/Ind ( n = 253 : 193 from r and omized Per/Ind group and 60 from the placebo group switched at week 12 ) . The mean decreases in systolic blood pressure were similar in essential hypertension and ISH ( systolic blood pressure 23.2 versus 22.7 mmHg , respectively ) . Per/Ind treatment ( n = 253 ) achieved an initial normalization of blood pressure in 96.2 % [ 95 % confidence interval ( CI ) 93.6–98.9 % ; Kaplan-Meier estimate ] of Per/Ind-treated patients ; 79.8 % ( 95 % CI 74.1–85.5 % ) of these maintained a normalized blood pressure throughout the 1-year follow-up . The incidence of adverse events was similarly low in the placebo and active therapy groups . Efficacy and safety results for the over 75 years subgroup were similar to those for the younger elderly subjects Conclusions The fixed , very low-dose combination of perindopril 2 mg/indapamide 0.625 mg results in sustained blood pressure control when used as first line treatment of elderly hypertensive patients over 1-year , and is well-tolerated
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 .