[BP.06.03] COMPARATIVE EFFECTS OF VALSARTAN AND EITHER CILNIDIPINE OR HYDROCHLOROTHIAZIDE ON MORNING BLOOD PRESSURE SURGE IN MORNING HYPERTENSIVE PATIENTS. (September 2017)

• Record Type: Journal Article
• Authors: Fujiwara, T.; Tomitani, N.; Kanegae, H.; Kario, K.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523763.92715.37
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: We previously reported that cilnidipie significantly reduced morning systolic blood pressure (BP) markedly in patients with higher baseline morning systolic BP (SBP) and restored abnormal nocturnal BP dipping status toward a normal dipping pattern. The diuretic was reported to reduce nocturnal BP greater than calcium channel blocker. However, the effects for the reduction of morning surge, which was calculated as morning BP minus nocturnal BP, remains unclear between valsartan/cilnidipine and valsartan/hydrochlorothiazide (HCTZ) combination. The objective of this study was to test the hypothesis that the valsartan/cilnidipine combination suppress morning surge more than the valsartan/HCTZ combination in patients with morning hypertension. Design and method: This study was a 8-week prospective, multicenter, randomized, open-label clinical trial conducted in Japan. Patients were asked to measure home BP twice each at morning and bedtime during the study period and nocturnal BP over 3 nights prior to the study randomization and the end of treatment. We defined morning surge as mean morning SBP minus mean nocturnal SBP, both measured by home BP monitoring in the same day. Patients who met all of following inclusion criteria were eligible: (1) hypertensive patients with home morning SBP >135 mmHg or diastolic BP >85 mmHg over 3 days, (2) prior medications with valsartan 80 mg. Eligible patients were randomly allocated to either valsartan/cilnidipine (80/10 mg) or valsartan/HCTZ (80/12.5 mg) combination groups. Results: A total of 129 patients were randomly allocated to valsartan/cilnidipine combination (63 patients; 68.4 ± 13.0 years, 42.9% male) or valsartan/HCTZ combination (66 patients; 67.3 ± 11.7 years, 43.9% male) groups. Baseline morning SBP, nocturnal SBP and morning surge were as follows: 142.4 ± 14.6 vs. 142.4 ± 15.7 mmHg (p = 0.981), 124.3 ± 15.6 vs. 125.7 ± 15.2 mmHg (p = 0.616) and 17.5 ± 13.4 vs. 16.8 ± 13.9 mmHg (p = 0.786), respectively. At the end of treatment period, each parameter was significantly reduced from baseline in both groups. However, there was not a significant difference in morning surge between valsartan/cilnidipine and valsartan/HCTZ combination groups: 14.4 ± 13.0 vs. 14.0 ± 15.2 (p = 0.898). Conclusions: The morning surge was significantly reduced both in valsartan/cilnidipine and valsartan/HCTZ combination groups from baseline. The valsartan/cilnidipine combination could not significantly suppress morning surge compared to valsartan/HCTZ combination.