Key result
ACE inhibitors with appropriate pharmacokinetics, such as perindopril, can achieve adequate 24-hour blood pressure control with once-daily dosing even when titrated at peak response.
Answers are grounded in this paper and cite their sources.
Highlights the importance of considering drug pharmacokinetics and the timing of blood pressure measurements to ensure adequate 24-hour blood pressure control with once-daily anti-hypertensive therapy.
Blood pressure should be controlled over 24 h to reduce or prevent cardiac hypertrophy and reduce the prevalence of sudden death, myocardial infarction and myocardial ischaemia at the time of the morning rise in blood pressure. Anti-hypertensive medication is usually given once-daily in the morning and the dose is titrated on the basis of post-dose (peak) blood pressure. This frequently leads to inadequate control prior to the next drug dose unless drugs with appropriate pharmacokinetics or pharmacodynamics are used. ACE inhibitors exhibit an Emax plasma concentration:blood pressure response relationship, and thus short-acting ACE inhibitors can exert an effect over 24 h if titrated based on pre-dose (trough) blood pressure. However, when titrated in clinical practice on post-dose (peak) blood pressure response, doses are used that are inadequate to control blood pressure for 24 h. ACE inhibitors with appropriate pharmacokinetics such as perindopril can control blood pressure when titrated at peak provided a dose is used (4 or 8 mg) that is known to have a T:P close to 1·0. Shorter-acting ACE inhibitors frequently give inadequate control when titrated at peak. An understanding of the pharmacokinetics and pharmacodynamics of a drug, coupled with knowledge of the time the drug was taken, together with the time of blood pressure measurements, enables control to be achieved with once-daily therapy even if the drug is titrated at peak response.
No takes yet. Share an insight, caveat, or question.
T. Morgan (1997) conducted a review in Hypertension. ACE inhibitors (e.g., perindopril) vs. Shorter-acting ACE inhibitors was evaluated on Blood pressure control over 24 h. ACE inhibitors with appropriate pharmacokinetics, such as perindopril, can achieve adequate 24-hour blood pressure control with once-daily dosing even when titrated at peak response.
Synapse has enriched 10 related papers. Consider them for comparative context: