ASSESSMENT OF ANTIHYPERTENSIVE TREATMENT BY AMBULATORY BLOOD-PRESSURE

Advantages of ambulatory blood pressure monitoring Ambulatory blood pr essure monitoring is now used widely to assess the efficacy of antihyp ertensive drugs in daily life conditions, These 24-h measurements have a number of advantages compared to conventional sphygmomanometric rea dings. Although a small placebo effect is observed in the first few ho urs after placebo administration, 24-h average blood pressure is subst antially devoid of any placebo effect Moreover, ambulatory blood press ure is not affected by the alerting reaction usually observed during t he doctor's visit When the 24-h average value is considered, ambulator y blood pressure is more reproducible than clinic blood pressure, Fina lly, ambulatory blood pressure is prognostically more important than c linic blood pressure, since the end-organ damage associated with hyper tension is more closely related to 24-h than to clinic blood pressure, Ambulatory blood pressure monitoring is therefore particularly useful when testing the efficacy of new antihypertensive agents on 24-h bloo d pressure. Testing the combination of verapamil and trandolapril In a recent study we evaluated the efficacy of a fixed combination of vera pamil and trandolapril using both clinic and ambulatory blood pressure measurements. Ambulatory blood pressure monitoring showed that the ef fect of the combination of verapamil and trandolapril was greater than the effect of either of the two drugs administered alone. However, th e clinic blood pressure measurements failed to show any systematically greater effect with the combination versus monotherapy. This further indicates that ambulatory blood pressure is superior to conventional b lood pressure in the assessment of antihypertensive drugs.