508 EFFECT OF ANTIHYPERTENSIVE TREATMENT ON MORNING BLOOD PRESSURE SURGE. DETAILED ASSESSMENT BY COMBINATION OF 24 H AMBULATORY BLOOD PRESSURE MONITORING AND POLYSOMNOGRAPHY

Abstract

Background: The rate of morning blood pressure rise, appears to significantly contribute to the higher morning incidence of cardiovascular events. Aim of our study was to compare the effects of once a day administration of Telmisartan (T) and Valsartan (V) in patients with mild to moderate hypertension, according to a randomized, double-blind design. Sleep was objectively quantified by polysomnography. Methods: 31 consecutive patients with essential hypertension were enrolled. Patients underwent 24 h ambulatory (A) BP monitoring and full polysomnography combined with beat by beat BP monitoring, under placebo (P), T 80 mg and V 160 mg. Results: At the end of each 2 month treatment period the rate of patients with controlled ASBP and ADBP with T and V, respectively, was 95% vs 50% for early morning hours; 62% vs 37% for 24 h ABP; 69% vs 31% for daytime ABP and 69% vs 50% for night-time ABP, (all T-to-V differences p < 0.05). The corresponding rates of ABP normalization with P were 50% for early morning hours, 0% for 24 h, 12% for daytime,14% for night-time ABP. The rate of clinic BP normalization was 81% vs 62% with T vs V respectively (p < 0.05). The proportion of dippers was 69% with P, 75% with T and 56% with V (T vs P and T vs V p < 0.05). Conclusions: T administration offered a significantly better clinic and 24 h ABP control than either P or V, also when focusing on early morning hours. T on morning administration was also associated with greater ABP dipping rate than P or V.