MEASUREMENT OF LONG-TERM HEMODYNAMIC-CHANGES AND THE USE OF 24-HOUR BLOOD-PRESSURE MONITORING TO EVALUATE TREATMENT

Hemodynamic studies at rest as well as during exercise are useful for profiling the hemodynamic derangements in essential hypertension and f or evaluating the changes produced by antihypertensive therapy. Modern , lightweight, 24-hour ambulatory blood pressure monitoring devices ca n provide useful information in understanding circadian variation of b lood pressure, and also in evaluating blood pressure control over 24 h ours. We have studied in >400 patients the hemodynamic profiles of mos t of the commonly used antihypertensive agents. Results from our study of amlodipine, a novel calcium antagonist, are presented as an exampl e. Nineteen patients with mild-to-moderate essential hypertension unde rwent invasive hemodynamic studies while at rest, supine, and sitting, and during 50, 100, and 150 W bicycle exercise in the sitting positio n. Systolic, diastolic, and mean arterial blood pressure decreased 16% (p <0.01) at rest and during exercise, and total peripheral resistanc e was reduced 18%. Blood pressure during the daytime and during sleep was reduced approximately 16%. The reductions in systolic and diastoli c pressures were similar. There were no significant changes in heart r ate or cardiac output. Amlodipine was well tolerated. Two patients dev eloped ankle edema, which disappeared when the dose was reduced, and i n 1 patient the drug was withdrawn because of nondrug-related side eff ects.