Blood pressure variability (BPV) over 24 hours has been shown to be a significant and independent risk factor for cardiovascular (CV) morbidity and mortality. 24-Hour ambulatory blood pressure monitoring (ABPM) was used to assess the effect on 24-hour BPV of a new first-line combination treatment recently approved in Europe (perindopril/amlodipine 3.5 mg/2.5 mg [P/A 3.5/2.5]) versus a range of first-line monotherapy strategies.Design and method:
On-treatment 24-hour BPV was indirectly estimated using the smoothness index (SI), an index reflecting the homogeneity of BP reduction obtained by drug therapy over 24 hours which was found to be inversely related to 24-hour BPV. It was determined using data from 886 hypertensive patients from two international, double-blind, parallel-group, randomized controlled trials. P/A 3.5/2.5 was compared to first-line RAAS inhibition with an angiotensin receptor blocker (ARB) at 1 month, and with an angiotensin-converting enzyme inhibitor (ACEi) at 2 months.Results:
In these comparisons, P/A demonstrated superior efficacy in reducing mean 24-hour BP (P < 0.05 vs other first-line treatments) over the other treatments. After 1 month, the systolic BP (SBP)/diastolic BP (DBP) SI for the P/A 3.5/2.5 group (n = 67) was greater than that of the irbesartan 150 mg group (n = 77): 0.90 ± 0.86/0.68 ± 0.71 vs 0.50 ± 0.63/0.36 ± 0.50, respectively (P < 0.001 / P = 0.001). After 2 months, the SBP/DBP SI for the P/A 3.5/2.5 group (n = 174) was superior to that of the perindopril 5 mg group (n = 187): 0.69 ± 0.87/0.57 ± 0.82 vs. 0.38 ± 0.94/0.35 ± 0.77, respectively (P < 0.001 / P = 0.007).Conclusions:
The new first-line single-pill perindopril/amlodipine strategy, significantly reduces 24-hour mean BP more than RAAS monotherapies and provides a significantly greater SI, and therefore a greater reduction of 24-hour variability. Achieving a homogeneous 24-h BP control has been shown to have important clinical implications and may contribute to the improvement of CV outcomes by reducing 24-h BP variability, decreasing end organ damage, and thus reducing CV risk.