Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Essential hypertension (n=1920). Intervention: Calcium channel blockers (CCB) vs. Diuretics. Primary outcome: Nighttime BP control (< 120/70 mmHg) (OR 0.41, 95% CI 0.21-0.79, p=0.007).

Q: What does this research mean for the field?

In older hypertensive patients, calcium channel blocker monotherapy is associated with a significantly lower probability of achieving nighttime blood pressure control compared to diuretic monotherapy, while beta-blocker-based regimens provide lower daytime blood pressure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Peipei Lu; Meng Xu; Ying Zhang; Yanqi Li; Shu Wang; Lisheng Liu; Wen Wang; Yuling Li; Yuqing Zhang; Aihua Hu; Xianliang Zhou; Lihong Ma

doi:10.11909/j.issn.1671-5411.2019.04.005

April 1, 2019Open Access

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy.

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Key result

Calcium channel blocker monotherapy was associated with a significantly lower probability of achieving nighttime blood pressure control compared to diuretic monotherapy (18.0% vs 33.3%, OR 0.41) in older hypertensive patients.

Figures

Why the study?

To evaluate differences in 24-hour ambulatory blood pressure in older hypertensive patients treated with five major antihypertensive drug classes, as monotherapy or dual combination therapy, to improve daytime and nighttime control.

Do different antihypertensive monotherapy or dual combination therapies provide different 24-hour ambulatory BP control and nighttime BP dip patterns in older patients with essential hypertension?

Study Design

Type

Observational (n=1,920)

Multicenter

Yes

Structured PICO

Do different antihypertensive monotherapy or dual combination therapies provide different 24-hour ambulatory BP control and nighttime BP dip patterns in older patients with essential hypertension?

P

Population

1920 Chinese community-dwelling outpatients aged ≥ 60 years with essential hypertension

I

Intervention

Antihypertensive monotherapy or dual combination therapy using the five major classes of antihypertensive drugs

C

Comparator

Other antihypertensive regimens (comparative analysis between different classes and combinations)

O

Outcome

Ambulatory BP values, ambulatory BP control (24-hour BP < 130/80 mmHg; daytime mean BP < 135/85 mmHg; and nighttime mean BP < 120/70 mmHg), and nighttime BP dip patternssurrogate

Main Result

Effect estimate: OR 0.41 (95% CI 0.21-0.79)

Absolute Event Rate: 18% vs 33.3%

p-value: p=0.007

In older hypertensive patients, beta-blocker-based regimens are associated with lower daytime blood pressure, while diuretic-based therapies are associated with lower nighttime blood pressure.

Limitations

Observational study without baseline BP information, which can influence drug selection and BP values
Lack of data for clinical factors that may influence drug class selection, such as comorbidities, medication doses, and frequency
Patients were exclusively older Chinese individuals, which may limit generalizability to younger patients and other ethnic groups

Implication

Caution advised with CCB monotherapy for nighttime BP targets in older hypertensives; leaves open confirmation in randomized trials.

Abstract

OBJECTIVE: To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs, as monotherapy or dual combination therapy, to improve daytime and nighttime BP control. METHODS: We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg; daytime mean BP < 135/85 mmHg; and nighttime mean BP < 120/70 mmHg), as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. CONCLUSIONS: Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP, whereas diuretic-based therapies provided lower nighttime BP, compared with other antihypertensive regimens.

Discussion

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Cite This Study

Lu et al. (2019) conducted an observational in Essential hypertension (n=1,920). Calcium channel blockers (CCB) vs. Diuretics was evaluated on Nighttime BP control (< 120/70 mmHg) (OR 0.41, 95% CI 0.21-0.79, p=0.007). Calcium channel blocker monotherapy was associated with a significantly lower probability of achieving nighttime blood pressure control compared to diuretic monotherapy (18.0% vs 33.3%, OR 0.41) in older hypertensive patients.

synapsesocial.com/papers/6a14a7156667a4fa718ef59e https://doi.org/10.11909/j.issn.1671-5411.2019.04.005

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Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy.

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy.

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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