Document Detail

Decrease in urinary albumin excretion associated with the normalization of nocturnal blood pressure in hypertensive subjects.
MedLine Citation:
PMID:  16144987     Owner:  NLM     Status:  MEDLINE    
Previous results have indicated that valsartan administration at bedtime as opposed to on wakening improves the diurnal/nocturnal ratio of blood pressure without loss in efficacy and therapeutic coverage. We hypothesized that increasing this ratio could reduce microalbuminuria. We conducted a prospective, randomized, open-label, blinded endpoint trial on 200 previously untreated nonproteinuric patients with grade 1 to 2 essential hypertension, assigned to receive valsartan (160 mg/d) as a monotherapy either on awakening or at bedtime. Blood pressure was measured by ambulatory monitoring for 48 consecutive hours before and after 3 months of treatment. Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately calculate the diurnal and nocturnal means of blood pressure on a per-subject basis. The significant blood pressure reduction after 3 months of therapy was similar for both treatment times. The diurnal/nocturnal blood pressure ratio was unchanged after valsartan on awakening, but significantly increased from 7.5 to 12.2 (P<0.001) when valsartan was administered at bedtime. Urinary albumin excretion was significantly reduced by 41% after bedtime treatment. This reduction was independent of the 24-hour blood pressure decrease but highly correlated with the decrease in nocturnal blood pressure and mainly with the increase in diurnal/nocturnal ratio (P<0.001). Bedtime valsartan administration improves the diurnal/nocturnal blood pressure ratio to a more dipper profile. This normalization of the circadian blood pressure pattern is associated with a significant decrease in urinary albumin excretion and plasma fibrinogen, and could thus reduce the increased cardiovascular risk in nondipper hypertensive patients.
Ramón C Hermida; Carlos Calvo; Diana E Ayala; José E López
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2005-09-06
Journal Detail:
Title:  Hypertension     Volume:  46     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-30     Completed Date:  2005-12-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  960-8     Citation Subset:  IM    
Bioengineering Laboratory, University of Vigo, Campus Universitario, Vigo, Spain.
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MeSH Terms
Albuminuria / physiopathology*
Angiotensin II Type 1 Receptor Blockers / administration & dosage*,  therapeutic use
Blood Pressure / drug effects*
Blood Pressure Monitoring, Ambulatory
Circadian Rhythm*
Double-Blind Method
Drug Administration Schedule
Fibrinogen / metabolism
Hypertension / drug therapy*,  physiopathology*,  urine
Middle Aged
Prospective Studies
Tetrazoles / administration & dosage*,  therapeutic use
Valine / administration & dosage,  analogs & derivatives*,  therapeutic use
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Tetrazoles; 137862-53-4/valsartan; 7004-03-7/Valine; 9001-32-5/Fibrinogen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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