October 1, 1995Journal of Hypertension
Calculation of trough: peak ratio of antihypertensive treatment from ambulatory blood pressure: methodological aspects
Why the study?
How should the trough:peak ratio of antihypertensive treatment be optimally calculated from 24-hour ambulatory blood pressure recordings?
Population
319 patients with mild essential hypertension pooled from parallel group (n=280) or cross-over studies (n=39)
Comparison
Antihypertensive treatment with calcium… vs Placebo
Design
Cohort
Follow-up
4 to 8 weeks
Authors
Discussion
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Implication
Calculation over 2-hour windows in responders may enhance ABPM reproducibility; leaves open standardization of trough:peak methods for efficacy assessment.
Key Points
- The aim is to address methodological issues in calculating the trough:peak ratio from 24-hour ambulatory blood pressure recordings.
- Pooled data from mild essential hypertension patients in parallel group (n=280) and cross-over studies (n=39).
- Measured blood pressure at intervals during treatment phases with calcium antagonists, ACE inhibitors, and placebo.
- Calculated peak changes from measurements taken 2-8 hours after drug intake and trough changes from the last 4 hours of 24-hour recordings.
- Peak changes became progressively lower with data averaged over 1, 2, 4, and 6 hours, achieving optimal reproducibility at 2 hours.
- Trough:peak ratios displayed non-normal distributions; normality was achieved by selecting treatment responders.
- Placebo resulted in modest peak changes but no trough effect; significant differences arose when correcting for individual subjects in cross-over studies.
Structured PICO
How should the trough:peak ratio of antihypertensive treatment be optimally calculated from 24-hour ambulatory blood pressure recordings?
P
Population
319 patients with mild essential hypertension pooled from parallel group (n=280) or cross-over studies (n=39)
I
Intervention
Antihypertensive treatment with calcium antagonists (n=143) or angiotensin converting enzyme inhibitors (n=103) for 4 to 8 weeks
C
Comparator
Placebo (n=73 from parallel group studies and n=39 from cross-over study)
O
Outcome
Methodological assessment of trough:peak ratio calculation from 24 h ambulatory blood pressure recordingssurrogate
When assessing the trough:peak ratio from ambulatory blood pressure, computing changes over a 2-hour window in treatment responders provides the best compromise between peak estimate accuracy and reproducibility.
Cite This Study
Omboni et al. (1995) studied this question.