NOCTURNAL REDUCTION OF BLOOD-PRESSURE AND THE ANTIHYPERTENSIVE RESPONSE TO A DIURETIC OR ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR IN OBESE HYPERTENSIVE PATIENTS

During a 12-week, multicenter study to evaluate the efficacy and safet y of lisinopril and hydrochlorothiazide (HCTZ) for the treatment of ob esity-related hypertension, ambulatory blood pressure (ABP) monitoring was performed both at baseline and at study completion in 124 patient s. Patients were randomized to three groups: placebo, lisinopril (10, 20, or 40 mg/day), or HCTZ (12.5, 25, or 50 mg/day). All groups were m atched with regard to sex, race, age, body mass index, and waist/hip r atio. The primary analysis of ABP data revealed that both lisinopril a nd HCTZ effectively lowered mean 24-h systolic (SBP) and diastolic (DB P) blood pressure compared with placebo, (mean change from baseline SB P/DBP: -12.0/-8.2, -10.6/-5.5, and -0.3/-0.5 mm Hg, respectively); how ever, lisinopril lowered DBP better than HCTZ (P <.05). Secondary anal yses of groups revealed that men responded better to lisinopril than H CTZ (-11.9/-7.3 v -6.6/-3.5 mm Hg, respectively), whereas women respon ded well to both drugs. White patients responded better to lisinopril than HCTZ, whereas black patients showed a significant response to HCT Z only. Response to treatment was also influenced by patient classific ation of 24-h blood pressure profiles, ie, ''dipper'' or ''nondipper.' ' Overall, the majority of obese hypertensives were nondippers. Nondip pers (n = 82) responded well to both drugs (-10.4/-6.9 v -12.5/-5.7 mm Hg, P <.05 v placebo), whereas dippers (n 42) responded to lisinopril (-11.7/-9.4 mm Hg, P <.05 v placebo and HCTZ), but not HCTZ (-5.6/-4.1 mn Hg, P = NS v placebo). Results of 24-h ABP data show that both lis inopril and HCTZ are effective therapies for obesity-related hypertens ion and that response to treatment is influenced by sex, race, and dip per/nondipper status. Am J Hypertens 1998; 11:914-920. (C) 1998 Americ an Journal of Hypertension, Ltd.