DIFFERENTIAL-EFFECTS OF ANTIHYPERTENSIVE DRUGS WITH DIFFERING PHARMACOLOGICAL PROPERTIES ON THE BASAL AMBULATORY BLOOD-PRESSURE

To investigate how antihypertensive drugs with different pharmacologic al properties affect ambulatory blood pressure (BP) the JAPANESE Study Group developed a database of clinic and ambulatory BPs before and af ter antihypertensive treatment of patients throughout Japan. Drugs eva luated were nilvadipine (n = 195; b.i.d, 4-8 mg/day), amlodipine (n = 75; q.d., 2.5-10 mg/day), lisinopril (n = 80; q.d., 10-20 mg/day) and bisoprolol (n = 49; q.d., 5-10 mg/day). The relationship between basal ambulatory BP and the hypotensive effect on ambulatory BP during trea tment was examined. All antihypertensive drugs significantly decreased both clinic BP and ambulatory BP. The hypotensive effect determined b y measurement of clinic BP was significantly greater than that determi ned by ambulatory BP. The hypotensive effect was positively correlated with basal ambulatory BP. However, there was a quantitative differenc e in this characteristic among the drugs. The critical daytime systoli c ambulatory BP below which a hypotensive effect was not observed was extrapolated to 128, 127 and 124 mm Hg with nilvadipine, amlodipine an d bisoprolol, respectively, while that with lisinopril was 97 mm Hg. T he slope of the correlation coefficient between basal daytime ambulato ry systolic BP and hypotensive effect with lisinopril was significantl y smaller than those with the other drugs (P < 0.0001). The slope for the relationship between night-time ambulatory systolic BP and the hyp otensive effect with bisoprolol was the steepest (P < 0.0001). Antihyp ertensive drugs with different pharmacological properties exhibited di ffering hypotensive effects on the basal ambulatory BP. Such differenc es in efficacy of the drugs on the basal ambulatory BP may reflect adv erse effects of the drugs and the prognosis of hypertension.