It has been long believed that there is a close association between hypertension and atrial fibrillation (AF). However, there have been few studies on the impact of antihypertensive medication in hypertensives with AF. To investigate whether the timing of the antihypertensive drug administration influences blood pressure (BP) level and biomarkers to hypertensives with AF.Design and Method:
The present study was a multicentered, prospective, randomized, open-labelled clinical trial to investigate the difference in the effect of telmisartan/amlodipine combination tablets on BP levels and BP variability using ambulatory BP monitoring (ABPM) and home BP between the morning administration and the bedtime administration in hypertensives with paroxysmal AF. ClinicalTrials.gov number NCT01748253.Results:
In hypertensives with AF, 24-hour BP, night-time BP, preawake BP and morning BP by ABPM were significantly reduced, and their antihypertensive effects were similar regardless of timing of administration. The standard deviation of night-time BP was also significantly reduced. In addition, day-by-day home SBP variability and maximum home SBP were significantly reduced, and their effects were similar regardless of the timing of administration. On the other hand, levels of N-terminal pro-brain natriuretic peptide, urinary albumin/creatinine ratio and high-sensitivity troponin T were significantly decreased in the bedtime administration group only (Table).Conclusions:
Telmisartan/amlodipine combination tablets maintained the effects by significantly reducing 24-hours BP as well as short-term BP variability regardless of the timing of administration in high-risk hypertensives with AF. Based on the results of the biomarker examination, the combination tablets are expected to be possible to maximize the reduction in the risk of developing AF recurrence and organ damage at bedtime administration.