Combined Effect of Angiotensin II Receptor Blocker and Either a Calcium Channel Blocker or Diuretic on Day-by-Day Variability of Home Blood Pressure: The Japan Combined Treatment With Olmesartan and a Calcium-Channel Blocker Versus Olmesartan and Diuretics Randomized Efficacy Study

Y. Matsui, M. F. O'Rourke, S. Hoshide, J. Ishikawa, K. Shimada, K. Kario
2012 Hypertension  
Day-by-day home blood pressure (BP) variability (BPV) was reported to be associated with increased cardiovascular risk. We aimed to test the hypothesis that the angiotensin II receptor blocker/calcium-channel blocker combination decreases day-by-day BPV more than the angiotensin II receptor blocker/diuretic combination does and investigated the mechanism underlying the former reduction. We enrolled 207 hypertensive subjects treated with olmesartan monotherapy for 12 weeks. The subjects were
more » ... omly assigned to treatment with hydrochlorothiazide (nϭ104) or azelnidipine (nϭ103) for 24 weeks. Home BP was taken in triplicate with a memory-equipped device in the morning and evening, respectively, for 5 consecutive days before each visit. Visits occurred at 4-week intervals. Home BPV was defined as within-individual SD of the 5-day home BP. Arterial stiffness was assessed by aortic pulse wave velocity at baseline and 24 weeks later. The reductions in home systolic BP were similar between the 2 groups, whereas the SD of home systolic BP decreased more in the azelnidipine group than in the hydrochlorothiazide group during the follow-up period (follow-up mean: 6.3 versus 7.1 mm Hg; Pϭ0.007). In the azelnidipine group, the change in aortic pulse wave velocity was independently associated with the change in SD of home systolic BP (regression coefficientϮSEϭ0.79Ϯ0.37; Pϭ0.036). This study demonstrated that the angiotensin II receptor blocker/calciumchannel blocker combination improved home BPV in addition to home BP reduction and that the reduction in home BPV was partly attributable to the arterial stiffness reduction by this combination. (Hypertension. 2012;59:1132-1138.) • Online Data Supplement Key Words: home blood pressure Ⅲ day-by-day home blood pressure variability Ⅲ calcium channel blocker Ⅲ thiazide diuretic Ⅲ angiotensin II receptor blocker Ⅲ pulse wave velocity T here is a growing body of evidence that visit-to-visit blood pressure (BP) variability (BPV) in a clinical setting was significantly associated with target organ damage 1-6 and that it could predict cardiovascular events independent of mean office BP level. 7-10 One drawback of the application of visit-to-visit office BPV for the routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to evaluate day-by-day home BPV, because this selfmeasurement makes it possible to obtain multiple BP values in a relatively short period under well-controlled conditions. 11 It was reported recently that the increased day-by-day home BPV, calculated as the SD of home BP, was associated with the severity of target organ damage in patients with hypertension 12 or diabetes mellitus 13 and with cardiovascular mortality in a community-dwelling population. 14 After treat-Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. This trial has been registered at www.clinicaltrials.gov (identifier NCT00607035). The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl/
doi:10.1161/hypertensionaha.111.189217 pmid:22547439 fatcat:2ngy3kog6bhi3kcnd6mhj43dna