The importance of 24-h blood pressure control

The primary goal of antihypertensive therapy is to restore blood pressure t o normal levels and to prevent the complications associated with hypertensi on. In order to maximize these goals by improving patient compliance, clini cal researchers have focused on developing antihypertensive agents that can be given once daily. These agents provide many advantages over multiple-do se daily therapies, but it should not be assumed that they are all equivale nt in providing adequate blood pressure control over the full 24-h dosing i nterval, Ambulatory blood pressure monitoring has uncovered important diffe rences in commonly used once-daily therapies and has provided additional in sights into the cardiovascular risks associated with high blood pressure lo ads and blood pressure variability. In addition to ambulatory blood pressur e monitoring data, the calculated trough:peak ratio provides useful informa tion on an agent's ability to provide smooth and consistent blood pressure control, Using such assessments, it has been found that agents with a troug h:peak ratio greater than or equal to 0.50 are better able to control blood pressure over the full 24 h while maintaining natural circadian patterns, Ambulatory blood pressure monitoring studies assessing a recently introduce d class of antihypertensive drugs, the angiotensin receptor blockers, have demonstrated 24-h efficacy with once-daily dosing, particularly with the ne wer agents. (C) 2001 Lippincott Williams & Wilkins.