A comparative review of the efficacy of antihypertensive agents on 24 h ambulatory blood pressure

BACKGROUND: Ambulatory blood pressure (ABP) monitoring has contributed sign ificantly to the diagnosis, prognosis and treatment of hypertension. Howeve r, most of the published reviews have not focused on the 24 h efficacy of c onventional and new antihypertensive agents as measured by ABP monitoring. OBJECTIVES: To discuss the importance of 24 h blood pressure control, and t o review the antihypertensive efficacy of conventional antihypertensive age nts and of angiotensin II type I receptor (AT(1)R) blockers as assessed by ABP monitoring. PATIENTS AND METHODS: The 24 h antihypertensive efficacy of the different c lasses of agents was reviewed based on clinical, randomized, double-blind t rials published in peer review journals. These trials were mainly performed in the authors' research unit but were performed in other centres as well. RESULTS AND CONCLUSIONS: Most antihypertensive agents provided 24 h ABP con trol. However, in the authors' experience, hydrochlorothiazide, some angiot ensin converting enzyme inhibitors and low dosages of the calcium antagonis t diltiazem did not permit: satisfactory blood pressure reduction as assess ed by ABP monitoring in truly hypertensive patients. AT(1)R blockers and es pecially those of the new generation characterized by tight and long lastin g AT(1)-receptor binding produced adequate 24 h ABP control and continued e ffectiveness during the high risk early morning hours.