Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
Clin Ther. 2013 Sep;35(9):1418-22. doi: 10.1016/j.clinthera.2013.07.428. Epub 2013 Aug 22.
In the treatment of hypertension, once-daily administration of long-acting antihypertensive drugs has been recommended for the improvement of treatment adherence; however, it is unclear whether dividing daily doses has the additional benefit of more ideal blood pressure (BP) control over a 24-hour period.
The aim of the study was to investigate whether dividing a 10-mg daily dose of amlodipine, a long-acting calcium channel blocker, is associated with increased trough plasma amlodipine concentrations, reduced arterial stiffness, and improved BP control over a 24-hour period.
Outpatients with essential hypertension were included this open-label, 2-period crossover study. The patients were administered amlodipine 10 mg/d in 2 divided doses for 8 weeks. At week 4, blood was collected just before amlodipine administration for the evaluation of trough plasma amlodipine concentrations. At week 8, 24-hour, daytime, nighttime, and early morning BP, as well as arterial stiffness, were measured using ambulatory BP monitoring (ABPM) and cardio-ankle vascular index (CAVI), respectively. In the subsequent study period, amlodipine 10 mg/d was administered once daily, and the same tests were performed at the same timings as in period 1.
Ten patients were enrolled (7 men, 3 women; mean age, 61.0 [15.3] years). Mean 24-hour BP with twice-daily administration was not significantly lower than that with once-daily administration (129.7 [7.3]/80.1 [7.9] mm Hg vs 130.5 [11.8]/80.1 [7.9] mm Hg, respectively). Similarly, there were no significant differences in daytime, nighttime, or early morning BP between twice- and once-daily administration. In addition, the differences in trough plasma amlodipine concentrations (22.37 [7.66] ng/mL vs 20.57 [8.22] ng/mL) and CAVI values (8.2 [1.8] vs 8.5 [1.0]) were not significantly different between twice- and once-daily administration.
Administering amlodipine in 2 divided doses was not associated with increased trough plasma amlodipine concentrations, reduced arterial stiffness, or improved BP control over a 24-hour period in patients with essential hypertension.
在高血压治疗中，建议使用每日一次的长效降压药物来提高治疗依从性；然而，目前尚不清楚将每日剂量分为两次是否会对 24 小时内的血压控制有更好的效果。
本研究旨在探讨将 10mg 氨氯地平（一种长效钙通道阻滞剂）的每日剂量分为两次给药是否会增加谷浓度、降低动脉僵硬度并改善 24 小时内的血压控制。
本开放标签、2 期交叉研究纳入了门诊高血压患者。患者接受氨氯地平 10mg 每日 2 次治疗 8 周。第 4 周，在氨氯地平给药前采集血样以评估谷浓度。第 8 周，使用动态血压监测（ABPM）和心踝血管指数（CAVI）分别测量 24 小时、白天、夜间和清晨血压以及动脉僵硬度。在随后的研究期间，患者每天服用氨氯地平 10mg，在与第 1 期相同的时间进行相同的测试。
共纳入 10 名患者（7 名男性，3 名女性；平均年龄 61.0[15.3]岁）。每日两次给药的 24 小时血压与每日一次给药相比没有显著降低（129.7[7.3]/80.1[7.9]mmHg 与 130.5[11.8]/80.1[7.9]mmHg，分别）。同样，两次与一次给药之间的白天、夜间或清晨血压也没有显著差异。此外，两次与一次给药之间的谷浓度（22.37[7.66]ng/mL 与 20.57[8.22]ng/mL）和 CAVI 值（8.2[1.8]与 8.5[1.0]）差异也没有统计学意义。
在原发性高血压患者中，将氨氯地平分为两次给药不会增加谷浓度、降低动脉僵硬度或改善 24 小时内的血压控制。
