Document Detail

Trough/peak ratios of once daily angiotensin converting enzyme inhibitors and calcium antagonists.
MedLine Citation:
PMID:  8806975     Owner:  NLM     Status:  MEDLINE    
Medications given once daily may increase compliance for treatment of hypertension, if the drugs have a prolonged duration of action. The time-effect profiles for antihypertensive drugs may not depend entirely on pharmacokinetic measurements (plasma levels). Thus, trough/peak effects on blood pressure should be measured. It has been suggested that trough/peak ratios be greater than 50% for optimal 24-h control of pressure. Because very little information is available for many angiotensin converting enzyme (ACE) inhibitors and calcium antagonists concerning their trough/peak ratios and awaiting prospective comparative trials with adequate methodology, we have analyzed the duration of action of blood pressure lowering during long-term therapy with commercially available ACE inhibitors and calcium antagonists in published studies that used ambulatory blood pressure monitoring. Published studies were searched in scientific databases using relevant key words. Twenty-four ACE inhibitor and 34 calcium antagonist studies with comparable methodologies were selected. The mean trough/ peak ratios were computed after reconstruction of the curve of the magnitude of blood pressure changes against time. The results showed that once daily administration of ACE inhibitors produced on average ratios higher than 50% with fosinopril (64%), ramipril (50% to 63%), and trandolapril (50% to 100%). Other studied ACE inhibitors produced ratios on average equal to [enalapril (40% to 64%), cilazapril (10% to 80%), lisinopril (30% to 70%)] or significantly lower than 50% [captopril (25%), benazepril (40%), perindopril (35%), quinapril (10% to 40%), and moexipril (0% to 9%)]. As for once daily calcium antagonists, amlodipine (50% to 100%), lacidipine (40% to 100%), nifedipine Coat-Core (50% to 69%), nifedipine gastrointestinal therapeutic system (GITS) (60% to 94%), as well as various "slow release" formulations of diltiazem (20% to 80%) and verapamil (45% to 100%) had on average ratios higher than 50% whereas felodipine ER (30% to 45%), various slow release formulations of isradipine (10% to 80%), and nitrendipine (10% to 80%) had ratios lower than 50%. Although this retrospective literature analysis may have some theoretical limitations, it suggests that not all once daily ACE inhibitors and calcium antagonists cause trough/peak ratio superior to 50%. This may have important clinical implications.
F Zannad; A Matzinger; J Larché
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  American journal of hypertension     Volume:  9     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-12-05     Completed Date:  1996-12-05     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  633-43     Citation Subset:  IM    
Clinical Pharmacology and Cardiology Department, University Henri Poincaré, Centre Hospitalier Universitaire, Nancy, France.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  pharmacokinetics*,  therapeutic use
Blood Pressure / drug effects,  physiology
Calcium Channel Blockers / administration & dosage,  pharmacokinetics*,  therapeutic use
Hypertension / drug therapy,  physiopathology
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Calcium Channel Blockers
Comment In:
Am J Hypertens. 1997 May;10(5 Pt 1):580-2   [PMID:  9160773 ]
Am J Hypertens. 1997 Oct;10(10 Pt 1):1190   [PMID:  9370392 ]
Erratum In:
Am J Hypertens 1997 Apr;10(4 Pt 1):482

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

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