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June 10, 1988, Vol 259, No. 22 >
ARTICLE | June 10, 1988

Characterization of Antihypertensive Therapy by Whole-Day Blood Pressure Monitoring FREE

Michael A. Weber, MD; Deanna G. Cheung, MD; William F. Graettinger, MD; Jodi L. Lipson, MPH
[+] Author Affiliations

Reprint requests to Veterans Administration Medical Center, W130, 5901 E Seventh St, Long Beach, CA 90822 (Dr Weber).


JAMA. 1988;259(22):3281-3285. doi:10.1001/jama.1988.03720220027020
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References

Whole-day ambulatory monitoring is used for diagnosing hypertension and for judging response to treatment. We evaluated both of these properties in an antihypertensive trial with the calcium channel blocker diltiazem hydrochloride. Measured by a conventional sphygmomanometer, systolic and diastolic blood pressures fell significantly in patients who received diltiazem, whereas no consistent changes occurred in those who received placebo. Administration of the drug also decreased systolic and diastolic blood pressures evenly throughout the day, as determined by automated monitoring. The 15 diltiazem-treated patients were subdivided into those whose clinically diagnosed hypertension was confirmed by pretreatment blood pressure monitoring (24-hour average diastolic blood pressure, ≥90 mm Hg; n=9) and those whose 24-hour blood pressures failed to meet this criterion (n=6). Diltiazem therapy decreased average whole-day blood pressures by 18/13 mm Hg in the hypertensives but by only 0/1 mm Hg in the others. Thus, whole-day blood pressure monitoring strengthens antihypertensive trials by documenting efficacy and duration of treatment. In addition, it enhances the diagnosis of hypertension, thereby identifying those patients in whom treatment seems justified.

(JAMA 1988;259:3281-3285)

REFERENCES

1 +
Zachariah PK, Sheps S, Schirger A, et al:  Verapamil and 24-hour ambulatory blood pressure monitoring in essential hypertension. Am J Cardiol 1986;;57:74D-79D.
2 +
Weber MA, Tonkon MJ, Klein RC:  Blood pressure monitoring for assessing the duration of action of antihypertensive treatment. J Clin Pharmacol 1987;;27:751-755.
3 +
Drayer JIM, Weber MA, Nakamura DK:  Automated ambulatory blood pressure monitoring: A study in age-matched normotensive and hypertensive men. Am Heart J 1985;;109:1334.
4 +
White W:  Assessment of patients with office hypertension by 24-hour noninvasive ambulatory blood pressure monitoring. Arch Intern Med 1986;;146:2196-2199.
5 +
Leonetti G, Sala C, Bianchini C, et al:  Antihypertensive and renal effects of orally administered verapamil. Eur J Clin Pharmacol 1980;;18:375-384.
6 +
Olivari MT, Bartorelli C, Polese A, et al:  Treatment of hypertension with nifedipine, a calcium antagonist agent. Circulation 1979;;59:1056-1061.
7 +
Trimarco B, DeLuca N, Ricciardelli B, et al:  Diltiazem in the treatment of mild to moderate essential hypertension: Comparison with metoprolol in a crossover double-bind trial. J Clin Pharmacol 1984;;24:218-227.
8 +
Weber MA, Drayer JIM, Nakamura DK, et al:  The circadian blood pressure pattern in ambulatory normal subjects. Am J Cardiol 1984;;54:115-119.
9 +
Graettinger WF, Lipson JL, Cheung DG, et al:  Validation of oscillometric, auscultatory and r-wave gated auscultatory automated portable BP measurements by intra-arterial line and sphygmomanometer. Am Heart J , in press.
10 +
Kirk RE: Experimental Design: Procedures for the Behavorial Sciences , ed 2. Monterey, Calif, Brooks/Cole Publishing Co, 1982;.
11 +
Raftery EB:  Understanding hypertension: The contribution of direct ambulatory blood pressure monitoring , in Weber MA, Drayer JIM (eds): Ambulatory Blood Pressure Monitoring . New York, Springer-Verlag NY Inc, 1984;.
12 +
Drayer JIM, Weber MA, De Young JL, et al:  Long-term blood pressure monitoring in the evaluation of antihypertensive therapy. Arch Intern Med 1983;;143:898-901.
13 +
Report by the Management Committee:  The Australian Therapeutic Trial in Mild Hypertension. Lancet 1980;;1:1261-1267.
14 +
Drayer JIM, Weber MA:  Monotherapy of essential hypertension with a converting enzyme inhibitor. Hypertension 1983;;5(part 2):108-113.
15 +
Kiowski W, Buhler FR, Fadayomi MO, et al:  Age, race, blood pressure and renin: Predictors for antihypertensive treatment with calcium antagonists. Am J Cardiol 1985;;56:81H-85H.

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1 +
Zachariah PK, Sheps S, Schirger A, et al:  Verapamil and 24-hour ambulatory blood pressure monitoring in essential hypertension. Am J Cardiol 1986;;57:74D-79D.
2 +
Weber MA, Tonkon MJ, Klein RC:  Blood pressure monitoring for assessing the duration of action of antihypertensive treatment. J Clin Pharmacol 1987;;27:751-755.
3 +
Drayer JIM, Weber MA, Nakamura DK:  Automated ambulatory blood pressure monitoring: A study in age-matched normotensive and hypertensive men. Am Heart J 1985;;109:1334.
4 +
White W:  Assessment of patients with office hypertension by 24-hour noninvasive ambulatory blood pressure monitoring. Arch Intern Med 1986;;146:2196-2199.
5 +
Leonetti G, Sala C, Bianchini C, et al:  Antihypertensive and renal effects of orally administered verapamil. Eur J Clin Pharmacol 1980;;18:375-384.
6 +
Olivari MT, Bartorelli C, Polese A, et al:  Treatment of hypertension with nifedipine, a calcium antagonist agent. Circulation 1979;;59:1056-1061.
7 +
Trimarco B, DeLuca N, Ricciardelli B, et al:  Diltiazem in the treatment of mild to moderate essential hypertension: Comparison with metoprolol in a crossover double-bind trial. J Clin Pharmacol 1984;;24:218-227.
8 +
Weber MA, Drayer JIM, Nakamura DK, et al:  The circadian blood pressure pattern in ambulatory normal subjects. Am J Cardiol 1984;;54:115-119.
9 +
Graettinger WF, Lipson JL, Cheung DG, et al:  Validation of oscillometric, auscultatory and r-wave gated auscultatory automated portable BP measurements by intra-arterial line and sphygmomanometer. Am Heart J , in press.
10 +
Kirk RE: Experimental Design: Procedures for the Behavorial Sciences , ed 2. Monterey, Calif, Brooks/Cole Publishing Co, 1982;.
11 +
Raftery EB:  Understanding hypertension: The contribution of direct ambulatory blood pressure monitoring , in Weber MA, Drayer JIM (eds): Ambulatory Blood Pressure Monitoring . New York, Springer-Verlag NY Inc, 1984;.
12 +
Drayer JIM, Weber MA, De Young JL, et al:  Long-term blood pressure monitoring in the evaluation of antihypertensive therapy. Arch Intern Med 1983;;143:898-901.
13 +
Report by the Management Committee:  The Australian Therapeutic Trial in Mild Hypertension. Lancet 1980;;1:1261-1267.
14 +
Drayer JIM, Weber MA:  Monotherapy of essential hypertension with a converting enzyme inhibitor. Hypertension 1983;;5(part 2):108-113.
15 +
Kiowski W, Buhler FR, Fadayomi MO, et al:  Age, race, blood pressure and renin: Predictors for antihypertensive treatment with calcium antagonists. Am J Cardiol 1985;;56:81H-85H.

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