ONCE-DAILY TRANDOLAPRIL COMPARED WITH THE TWICE-DAILY FORMULATION IN THE TREATMENT OF MILD-TO-MODERATE ESSENTIAL-HYPERTENSION - ASSESSMENT BY CONVENTIONAL AND AMBULATORY BLOOD PRESSURES

A double-blind, crossover study was carried out to compare the antihyp ertensive efficacy of the long-acting ACE inhibitor trandolapril 1 mg administered once daily and 0.5 mg twice daily in 31 patients with mil d to moderate essential hypertension. After randomization, patients en tered a single-blind placebo period of 4 weeks. After a double-blind t reatment of 4 weeks with either of the dosage regimens, patients were then crossed over to the alternate regimen for the last 4 weeks of the study. Conventional BP and heart rate were measured on each visit and ambulatory BP monitoring was done at baseline and at the end of each treatment phase. Conventional as well as 24-hour and awake ambulatory systolic and diastolic BPs were significantly (P < 0.001) and almost i dentically decreased by both once- and twice-daily formulations. Moreo ver, the clinical response rates (reduction in seated diastolic BP gre ater-than-or-equal-to 10% or diastolic BP less-than-or-equal-to 90 mm Hg) were similar with both treatment regimens (42% vs. 45% with the on ce- and twice-daily formulations, respectively). However, trandolapril twice daily exerted a significantly (p = 0.03) greater antihypertensi ve effect on systolic BP during sleep as compared with the once-daily formulation. Due to the fact that the minimal effective dose was used in this trial, further studies with higher doses should demonstrate ef fective 24-hour control of BP as described with other long-acting ACE inhibitors. In addition, our results suggest that ambulatory BP measur ements should be done in dose-response studies.