Key result
Twice-daily valsartan improves target BP achievement, 24-hour BP, and vascular stiffness versus once-daily regimens.
Why the study?
The efficacy of various dosage regimens of combination antihypertensive drugs on 24 hour BP profile, central aortic pressure, and vascular stiffness in arterial hypertension patients with ischemic stroke was not well established.
Does twice-daily or evening dosing of valsartan improve 24-hour blood pressure profiles, central aortic pressure, and vascular stiffness compared to morning dosing in hypertensive patients with recent ischemic stroke?
RCT (n=177)
Randomized to 3 groups
Does twice-daily or evening dosing of valsartan improve 24-hour blood pressure profiles, central aortic pressure, and vascular stiffness compared to morning dosing in hypertensive patients with recent ischemic stroke?
Answers are grounded in this paper and cite their sources.
Twice-daily dosing of valsartan provides superior 24-hour blood pressure control, central aortic pressure reduction, and vascular stiffness improvement compared to once-daily morning or evening dosing in hypertensive patients with recent ischemic stroke.
Aim. To assess and compare the efficacy of combination antihypertension drugs influence with various dosage regimens during 24 hour, on the parameters of daily blood pressure (BP) profile, central aortic pressure (CAP) and vessel wall stiffness in arterial hypertension (AH) patients with ischemic stroke (IS). Material and methods. To the study, 177 AH patients included, with IS within last 4 weeks. All patients were randomized to 3 groups depending on the regimen of antihypertensive drugs combination intake during 24 hours. At baseline and in 12 months of therapy all patients underwent 24 hour BP monitoring (ABPM), CAP measurement and vessel wall stiffness evaluation. Results. In 8 weeks of antihypertension therapy, target pressure level achievement was significantly more common in b. i.d. valsartan (group 3) comparing to once daily in the morning (group 1) or evening (group 2) (p<0,05). In all groups there were statistically significant positive changes in ABPM, CAP and stiffness. Also, in the group 2 there was significantly (p<0,05) more prominent decrease of the main ABPM, CAP and stiffness parameters than in the group 1. Valsartan b. i.d. led to significantly more prominent (p<0,05) improvement of the main ABPM, CAP and stiffness parameters improvement comparing to both variants of its once daily regimens. In 12 months of chronopharmacotherapy, in all groups, there was significant (p<0,05) increase of “dipper” 24 hour BP profile patients. Differences of the groups of “dippers” and “non-dippers” by the 12th month of treatment were significant for 3rd and 1st (p=0,0004), 3rd and 2nd (p=0,04) groups with the benefit for group 3. Conclusion. Two times a day or only evening intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of the main parameters of ABPM, CAP and vascular wall rigidity comparing to just morning intake. B.i.d. valsartan regimen led to significantly (p<0,05) more commonly reached target BP level, improved normalization of 24 hour BP in most of patients, led to more significant improvement of the main ABPM, CAP and vascular stiffness parameters comparing to once daily morning or evening regimen.
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А. В. Фендрикова (2018) conducted an RCT in Arterial hypertension with ischemic stroke (n=177). Valsartan with thiazide-like diuretic vs. Once daily morning intake was evaluated on Target pressure level achievement, 24-hour blood pressure profile, central aortic pressure, and vessel wall stiffness (p=<0.05). Twice daily valsartan led to more commonly reached target BP levels and improved 24-hour BP, central aortic pressure, and vascular stiffness compared to once daily regimens.
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