PP.31.03

Abstract

Objective: In recent years the role of home blood pressure measurement (HBP) in the assessment of the efficacy of antihypertensive therapy has increased. The information concerning the integrated use of HBP and 24-h BP monitoring (ABP) in chronotherapy trials is limited. The aim of our study was to assess the value of combined use of ABP and HBP in the open randomized cross-over study of verapamil-retard (VR) intake in morning (mo) vs. evening (ev). Design and method: We have analyzed data of 14 pts (mean age 58[10] (M [m]); 5 males) with stable essential hypertension. The duration of initial wash-out period was 2 weeks; the duration of both treatment courses - 3 weeks; the interval between courses - 1 week. Only pts with stable hypertension (mean day-time BP > 135/85 mm Hg) were recruited. ABP (Spacelabs 90207) was performed prior to treatment and at the end of both treatment courses. The pts performed HBP(A&D 767-PC with 126 measurements memory) throughout the study. The VR trial (mean daily dose 240.0[16.3]mg) included the compliance assessment by pharmacokinetics investigation. Pts were randomized to 9:00 or 21:00 treatment groups with VR in cross-over design. We studied 24-h,daytime (d), nighttime (n) means of systolic BP (SBP), mean BP (MBP), nocturnal BP fall (n fall) (ABP data), value of morning surge (moBP – evBP) - (ms) (HBP data). All values were calculated at baseline(B) and after 3 weeks of both courses of treatment. Paired Student's t-test was used to determine the significance of differences. Results: The main variables are shown in the table. Only HBP revealed significant difference for the mo and ms indices of SBP and MBP between two treatment groups. Both methods have detected significant decrease of BP only in the group of ev treatment.Conclusions: Both methods showed a more potent antihypertensive effect of the evening drug administration. Home blood pressure was able to detect superiority of the evening drug intake in the context of the morning blood pressure reduction and morning surge decrease. Therefore, home blood pressure might have an add-on value in assessment of antihypertensive efficacy.