TY - JOUR
T1 - Classic therapeutic trials in hypertension were patients vulnerable to unsuppressed peak morning blood pressure?
AU - Materson, Barry J.
AU - Preston, Richard A.
PY - 1991/7
Y1 - 1991/7
N2 - A metaanalysis of the major clinical trials on the benefits of antihypertensive therapy revealed that there is an overall reduction of coronary events by treatment, but that it is only about one-half of the reduction predicted. The reduction in stroke achieved the predicted number. This 'failure' has been attributed to study design, patient age at entry, preexisting disease, high-lipid diets, drug-associated cardiac dysrhythmias, and the 'J-curve' effect. It is also possible that the drugs used in these trials did not suppress the morning acceleration of blood pressure during which most coronary and cerebrovascular events occur. Ambulatory blood pressure monitoring studies suggest that antihypertensive drugs reduce drugs reduce overall blood pressure throughout the 24-h period, but do not change the circadian curve. The beneficial effect of antihypertensive therapy probably rests with the magnitude of blood pressure reduction. It is unlikely that lack of suppression of morning acceleration alone accounted for the failure of 'older' drugs to prevent as much cardiac mortality as expected.
AB - A metaanalysis of the major clinical trials on the benefits of antihypertensive therapy revealed that there is an overall reduction of coronary events by treatment, but that it is only about one-half of the reduction predicted. The reduction in stroke achieved the predicted number. This 'failure' has been attributed to study design, patient age at entry, preexisting disease, high-lipid diets, drug-associated cardiac dysrhythmias, and the 'J-curve' effect. It is also possible that the drugs used in these trials did not suppress the morning acceleration of blood pressure during which most coronary and cerebrovascular events occur. Ambulatory blood pressure monitoring studies suggest that antihypertensive drugs reduce drugs reduce overall blood pressure throughout the 24-h period, but do not change the circadian curve. The beneficial effect of antihypertensive therapy probably rests with the magnitude of blood pressure reduction. It is unlikely that lack of suppression of morning acceleration alone accounted for the failure of 'older' drugs to prevent as much cardiac mortality as expected.
KW - Blood pressure monitors circadian rhythm hypertension
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U2 - 10.1093/ajh/4.7.449S
DO - 10.1093/ajh/4.7.449S
M3 - Article
C2 - 1832872
AN - SCOPUS:0025886866
VL - 4
SP - 449S-453S
JO - American Journal of Hypertension
JF - American Journal of Hypertension
SN - 0895-7061
IS - 7
ER -