Trough-to-peak ratios and elimination half-lives of antihypertensive drugs: implications for 24-hour blood pressure control in primary care

Objective To compile and critically summarize published trough-to-peak (TP) ratios and elimination half-lives of antihypertensive drugs, providing a structured reference for research and clinical interpretation of 24-h blood pressure (BP) control. Design Systematic review. Data sources MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to June 2024. Selection of studies Clinical trials reporting TP ratios and pharmacokinetic studies reporting elimination half-life values of antihypertensive drugs were eligible. Data extraction TP ratio and elimination half-life values were extracted. Studies were classified according to Oxford levels of evidence for descriptive purposes. Randomized clinical trials reporting TP ratios were assessed for risk of bias using the Cochrane Risk of Bias tool (RoB 2). Results A total of 228 publications were included, providing data on 83 antihypertensive drugs across nine pharmacological classes. TP ratios were available for 69 drugs and elimination half-life values for 77 drugs. Substantial variability in TP ratios and elimination half-life values was observed across pharmacological classes and individual agents. Conclusions This systematic review compiles and organizes available TP ratio and elimination half-life data for most antihypertensive drugs. The resulting reference framework may support future research and facilitate the interpretation of 24-h BP control and antihypertensive treatment selection in clinical practice.