Abstract
Background: Blood pressure (BP) monitoring is an important aspect in the treatment of arterial hypertension (AH), namely the morning BP increase which is associated with an increased risk of cardiovascular and cerebrovascular incidents as well as sudden death. The study herein revealed clinical and functional predictors which decrease the morning BP rise in the case of optimal antihypertensive therapy with telmisartan, based on results of daily blood pressure monitoring (DBPM).
 Methods: A single-center open-label study in parallel groups was conducted. The study included 50 patients with AH who had previously received antihypertensive therapy but did not achieve a reduction in BP according to DBPM. Telmisartan (40 - 80 mg per day) was added to the treatment regimen of all patients. All patients underwent a general clinical examination, measurement of glucose and creatinine levels, assessment of lipid profile, ECG recording in 12 leads, echocardiography (EchoCG), and DBPM before treatment and after 12 weeks of treatment. Statistical data analyses were performed.
 Results: Twelve-week antihypertensive telmisartan-based therapy led to a decrease in mean systolic blood pressure (SBP) from 134.3 ± 5.0 to 126.2 ± 4.3 mm Hg (p = 0.008), and a decrease in mean diastolic blood pressure (DBP) from 79.8 ± 1.5 to 73.0 ± 1.4 mm Hg (p < 0.001). There was a decrease in the index of variability of DBP from 22.4 ± 2.8 to 16 ± 2.4 mm Hg (p < 0.001), and a decrease in the daily index of SBP from 15.7 ± 4.7 to 13.1 ± 4.7 mm Hg (p = 0.014). In the study, a connection was found between the decrease of the average morning index and the following indicators: presence of left ventricular (LV) hypertrophy on ECG, final diastolic size of the LV over 6.0 cm, LV ejection fraction below 52.3%, total cholesterol level over 5.5 mmol/L, LDL level greater than 3.3 mmol/L, and triglyceride level greater than 2.0 mmol/L.
 Conclusion: These values could be used as predictors of a decrease in the morning index during 12-week telmisartan therapy.
Highlights
It is well-known that blood pressure (BP) level has daily fluctuations in both healthy individuals and patients with varying degrees of arterial hypertension (AH)
The goal of this study was to identify and establish clinical, functional and anamnestic parameters that lead to a decrease in morning BP, as determined by daily blood pressure monitoring (DBPM), in the case of optimal antihypertensive therapy based on telmisartan
A decrease in the maximum morning systolic blood pressure (SBP) and diastolic blood pressure (DBP) was found in 96% of patients, a decrease in the morning surge magnitude (MSM) of SBP was observed in 94%, a decrease in MSM DBP was seen in 96%, a decrease in the morning SBP index in 98%, a decrease in morning DBP index in 94%, and a decrease in the average morning index in 84% of patients
Summary
It is well-known that blood pressure (BP) level has daily fluctuations in both healthy individuals and patients with varying degrees of arterial hypertension (AH). Blood pressure (BP) monitoring is an important aspect in the treatment of arterial hypertension (AH), namely the morning BP increase which is associated with an increased risk of cardiovascular and cerebrovascular incidents as well as sudden death. The study revealed clinical and functional predictors which decrease the morning BP rise in the case of optimal antihypertensive therapy with telmisartan, based on results of daily blood pressure monitoring (DBPM). Results: Twelve-week antihypertensive telmisartan-based therapy led to a decrease in mean systolic blood pressure (SBP) from 134.3 ± 5.0 to 126.2 ± 4.3 mm Hg (p = 0.008), and a decrease in mean diastolic blood pressure (DBP) from 79.8 ± 1.5 to 73.0 ± 1.4 mm Hg (p < 0.001).
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