Effects of valsartan monotherapy on the circadian blood pressure profile of patients with grade 1?2 essential hypertension

Angiotensin II receptor blockers (ARBs) are a relatively new class of antihypertensive medications that selectively and specifically antagonize the action of angiotensin II, a potent vasoconstrictor impacting blood pressure (BP) regulation. Valsartan is an orally active, specific, and selective ARB. After a single oral dose, the onset of its BP lowering action is within 2 hours, with peak effect occurring within 4–6 hours. We investigated the effects of valsartan on the 24-hour BP profile of hypertensive patients. We studied 187 patients with grade 1–2 essential hypertension (63 men), 50.4±13.3 (mean±SD) years of age, assigned to receive valsartan monotherapy (160 mg/day). BP was measured by ambulatory monitoring at 20-min intervals from 07:00 to 23:00 hours and at 30-min intervals at night for 48 consecutive hours before and after 3 months of treatment. Physical activity was simultaneously monitored every minute by wrist actigraphy, and the information used to determine diurnal and nocturnal means of BP for each patient according to individual resting time. Valsartan treatment resulted in a highly statistically significant reduction in BP from baseline after 3 months of treatment (14.8 and 10.5 mm Hg reduction in the 24-hour mean of systolic and diastolic BP, respectively; P<0.001). The BP reduction was highly significant (after correcting for multiple testing) at each of the 24 hourly means (P always <0.001). There was no effect of valsartan on heart rate (increase in the 24-hour mean of 0.17 beats/min, P=0.862). The circadian pattern of physical activity also remained unchanged (24-hour mean of 128 and 127 counts/min before and after treatment, respectively; P=0.661). There was also a highly significant reduction (P<0.001) of 4.3 mm Hg in the 24-hour mean of pulse pressure (PP). Results indicate that, despite its relatively short half-life, 160 mg/day valsartan efficiently reduce BP for the whole 24 hours of the day. Moreover, valsartan significantly reduces PP during the 24 hours. Apart from the progressive rise of PP with aging, a significant increase in PP has been documented, among other groups of interest, in hypertensive patients with type 2 diabetes. Thus, valsartan could be chosen, for added cardiovascular risk reduction, in the treatment of the elderly and diabetics with elevated PP, an issue that deserves further prospective investigation. Am J Hypertens (2004) 17, 110A–110A; doi: 10.1016/j.amjhyper.2004.03.284