Time of administration important? Morning versus evening dosing of valsartan.
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ABSTRACT: Studies suggest that bedtime dosing of an angiotensin-converting enzyme (ACE)-inhibitor or angiotensin receptor blocker shows a more sustained and consistent 24-h antihypertensive profile, including greater night-time blood pressure (BP) reduction. We compared the antihypertensive effects of morning (a.m.) and evening (p.m.) dosing of valsartan on 24-h BP.This 26-week, multicentre, randomized, double-blind study evaluated the efficacy and safety of valsartan 320?mg, dosed a.m. or p.m., versus lisinopril 40?mg (a.m.), a long-acting ACE-inhibitor, in patients with grade 1-2 hypertension and at least one additional cardiovascular risk factor. Patients (n?=?1093; BP?=?156?±?11/91?±?8?mmHg; 62 years, 56% male, 99% white) received (1?:?1?:?1) valsartan 160?mg a.m. or p.m. or lisinopril 20?mg a.m. for 4 weeks, then force-titrated to double the initial dose for 8 weeks. At Week 12, hydrochlorothiazide (HCTZ) 12.5?mg was added for 14 weeks if office BP was more than 140/90?mmHg and/or ambulatory BP more than 130/80?mmHg.Mean 24-h ambulatory SBP change from baseline to Weeks 12 and 26 was comparable between valsartan a.m. (-10.6 and -13.3?mmHg) and p.m. (-9.8 and -12.3?mmHg) and lisinopril (-10.7 and -13.7?mmHg). There was no benefit of valsartan p.m. versus a.m. on night-time BP, early morning BP and morning BP surge. Evening dosing also did not improve BP lowering in patients requiring add-on HCTZ or in nondippers at baseline. All treatments were well tolerated.Once-daily dosing of valsartan 320?mg results in equally effective 24-h BP efficacy, regardless of dosing time.ClinicalTrials.gov Identifier: NCT00241124.
SUBMITTER: Zappe DH
PROVIDER: S-EPMC4284009 | biostudies-literature | 2015 Feb
REPOSITORIES: biostudies-literature
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