Key result
Lercanidipine alone or in combination with enalapril significantly reduced short-term 24-hour blood pressure variability in elderly hypertensive patients, an effect independent of average blood pressure reduction.
Why the study?
Does lercanidipine, enalapril, or their combination reduce 24-hour short-term blood pressure variability in hypertensive patients?
RCT (n=130)
Single-blind and Double-blind
Randomized sequential order
Yes
Does lercanidipine, enalapril, or their combination reduce 24-hour short-term blood pressure variability in hypertensive patients?
Lercanidipine and its combination with enalapril effectively reduce short-term blood pressure variability independently of mean blood pressure reduction, with lercanidipine showing particular efficacy in elderly patients.
Cardiovascular events in hypertensives are associated with elevated average blood pressure (BP) and higher short-term BP variability (V), but little is known on treatment effects on BPV and on how to assess changes in short-term BPV. Aim of our study was to address the methodology of short-term BPV assessment and its reduction by Lercanidipine (L) or Enalapril (E) and their combination, through analysis of 24-hour ambulatory BP recordings from two studies including subjects of different age. Study-1: 64 middle-age hypertensives (52.9 ± 9.5 yrs) received L and E s.i.d. at 10 mg (L10, E10) or 20 mg doses (L20, E20) for 8 weeks. Study-2: 66 elderly hypertensives (65.5 ± 4.7 yrs) received placebo, L10, E20 and L10 + E20 s.i.d. for 4 weeks. In middle-age subjects, both L and E decreased mean BP and, at the highest dose, also short-term BPV. In elderly subjects, L10 alone or in combination with E20 reduced BPV. Treatment-induced reductions in BP levels and BPV were uncorrelated. Different methods for short-term BPV assessment did not always provide superimposable results in the elderly. Our study supports a better reduction of BPV by L in the elderly and by E + L combination at any age, suggesting BPV reduction to be independent from reduction in average BP.
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Parati et al. (2018) conducted an RCT in Essential hypertension (n=130). Lercanidipine and Enalapril vs. Placebo or baseline was evaluated on Short-term 24-hour blood pressure variability (weighted standard deviation [SDW] and average real variability [ARV]). Lercanidipine alone or in combination with enalapril significantly reduced short-term 24-hour blood pressure variability in elderly hypertensive patients, an effect independent of average blood pressure reduction.
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