Divergent Results Using Clinic and Ambulatory Blood Pressures
- 1 November 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 56 (5), 824-830
- https://doi.org/10.1161/hypertensionaha.110.156976
Abstract
Patients with resistant hypertension are at increased risk for cardiovascular events. The addition of new treatments to existing therapies will help achieve blood pressure (BP) goals in more resistant hypertension patients. In the current trial, 849 patients with resistant hypertension receiving ≥3 antihypertensive drugs, including a diuretic, at optimized doses were randomized to the selective endothelin A receptor antagonist darusentan, placebo, or the central α-2 agonist guanfacine. The coprimary end points of the study were changes from baseline to week 14 in trough, sitting systolic BP, and diastolic BP measured in the clinic. Decreases from baseline to week 14 in systolic BP for darusentan (−15±14 mm Hg) were greater than for guanfacine (−12±13 mm Hg; P P <0.001 for each comparison). The most frequent adverse event associated with darusentan was fluid retention/edema at 28% versus 12% in each of the other groups. More patients withdrew because of adverse events on darusentan as compared with placebo or guanfacine. We conclude that darusentan provided greater reduction in systolic BP in resistant hypertension patients as assessed by ambulatory BP monitoring, in spite of not meeting its coprimary end points. The results of this trial highlight the importance of ambulatory BP monitoring in the design of hypertension clinical studies.Keywords
This publication has 18 references indexed in Scilit:
- Combination therapy in hypertensionJournal of the American Society of Hypertension, 2010
- Efficacy of Spironolactone Therapy in Patients With True Resistant HypertensionHypertension, 2010
- A selective endothelin-receptor antagonist to reduce blood pressure in patients with treatment-resistant hypertension: a randomised, double-blind, placebo-controlled trialThe Lancet, 2009
- Resistant Hypertension: An Overview of Evaluation and TreatmentJournal of the American College of Cardiology, 2008
- Resistant Hypertension: Diagnosis, Evaluation, and TreatmentHypertension, 2008
- Effect of Spironolactone on Blood Pressure in Subjects With Resistant HypertensionHypertension, 2007
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Efficacy of low-dose spironolactone in subjects with resistant hypertensionAmerican Journal of Hypertension, 2003
- Darusentan: An effective endothelinA receptor antagonist for treatment of hypertensionAmerican Journal of Hypertension, 2002
- The Effect of an Endothelin-Receptor Antagonist, Bosentan, on Blood Pressure in Patients with Essential HypertensionThe New England Journal of Medicine, 1998