COMPARISON OF CLINICAL AND AMBULATORY BLO OD-PRESSURE MEASUREMENTS INPATIENTS WITH HYPERTENSION TREATED WITH BENAZEPRIL ALONE OR COMBINED WITH HYDROCHLOROTHIAZIDE

The aim of this study was to analyse the respective values of clinic a nd ambulatory blood pressure measurements in patients with treated hyp ertension. Twenty-eight patients with mild to moderate hypertension we re studied (clinic blood pressure greater than or equal to 160 / 95 mm Hg), treated with benazepril alone (n = 7) or combined with hydrochlor othiazide (nm = 21). A 24 h ambulatory blood pressure measurement was performed before (d0) and after 8 weeks of treatment (d56). The treatm ent was effective on the ambulatory blood pressure in 19 patients (Sta essen criteria) and effective on clinic measurements in 20 patients (W HO criteria). The results were concordant in 25 of the 28 patients. Th e decrease of the ambulatory blood pressure values during the day betw een d0 and d56 was not significantly related to the decrease of the cl inic values. The comparison of the ambulatory blood pressure values at each hour between d0 and d56 showed that the treatment was effective during 24 h. The 'white coat' effect has been evaluated at d0 and d56 by the difference between mean daytime ambulatory blood pressure and c linic values. Clinic values were higher than mean daytime ambulatory v alues in benazepril (14 +/- 12 mmHg and 7 +/- 7 mmHg for the systolic and diastolic pressure) and benazepril-hydrochlorothiazide group (12 /- 12 mmHg and 0.2 +/- 9 mmHg for the systolic and diastolic pressure) . This 'white coat' effect was not modified during the treatment. Prev ious studies have emphasized a better assessment of the cardiovascular risk with ambulatory than with clinic measurements. The differences i n the assessment of the efficiency of the treatment between clinic and ambulatory measurements shown in our study prompt us to use ambulator y measurements in patients with apparently uncontrolled hypertension.