Department of Medicine, Faculty of Clinical Sciences, University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Nigeria (D.B.O.).
Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.).
Hypertension. 2022 Nov;79(11):2593-2600. doi: 10.1161/HYPERTENSIONAHA.121.18333. Epub 2022 Sep 2.
The effect of 3 commonly recommended combinations of anti-hypertensive agents-amlodipine plus hydrochlorothiazide (calcium channel blocker [CCB]+thiazide), amlodipine plus perindopril (CCB+ACE [angiotensin-converting enzyme]-inhibitor), and perindopril plus hydrochlorothiazide (ACE-inhibitor+thiazide) on blood pressure variability (V) are unknown.
We calculated the blood pressure variability (BPV) in 405 patients (130, 146, and 129 randomized to ACE-inhibitor+thiazide, CCB+thiazide, and CCB+ACE-inhibitor, respectively) who underwent ambulatory blood pressure monitoring after 6 months of treatment in the Comparisons of Three Combinations Therapies in Lowering Blood Pressure in Black Africans trial (CREOLE) of Black African patients. BPV was calculated using the SD of 30-minute interval values for 24-hour ambulatory BPs and for confirmation using the coefficient of variation. Linear mixed model regression was used to calculate mean differences in BPV between treatment arms. Within-clinic BPV was also calculated from the mean SD and coefficient of variation of 3 readings at clinic visits.
Baseline distributions of age, sex, and blood pressure parameters were similar across treatment groups. Participants were predominately male (62.2%) with mean age 50.4 years. Those taking CCB+thiazide had significantly reduced ambulatory systolic and diastolic BPV compared with those taking ACE-inhibitor+thiazide. The CCB+thiazide and CCB+ACE-inhibitor groups showed similar BPV. Similar patterns of BPV were apparent among groups using within-clinic blood pressures and when assessed by coefficient of variation.
Compared with CCB-containing combinations, ACE-inhibitor plus thiazide was associated with higher levels, generally significant, of ambulatory and within-clinic systolic and diastolic BPV. These results supplement the differential ambulatory blood pressure-lowering effects of these therapies in the CREOLE trial.
目前尚不清楚 3 种常用降压药物组合（氨氯地平加氢氯噻嗪[钙通道阻滞剂（CCB）+噻嗪类]、氨氯地平加培哚普利[CCB+血管紧张素转换酶（ACE）抑制剂]和培哚普利加氢氯噻嗪[ACE 抑制剂+噻嗪类]）对血压变异性（V）的影响。
我们计算了 405 名患者（分别随机分配至 ACE 抑制剂+噻嗪类、CCB+噻嗪类和 CCB+ACE 抑制剂组的 130、146 和 129 名患者）在黑人降压三联疗法比较研究（CREOLE）中接受 6 个月治疗后进行的 24 小时动态血压监测的血压变异性（BPV）。BPV 通过 30 分钟间隔值的 SD 计算，并使用变异系数进行确认。线性混合模型回归用于计算治疗臂之间 BPV 的平均差异。还从诊所就诊时 3 次读数的平均 SD 和变异系数计算了诊所内的 BPV。
治疗组之间的年龄、性别和血压参数的基线分布相似。参与者主要为男性（62.2%），平均年龄为 50.4 岁。与服用 ACE 抑制剂+噻嗪类的患者相比，服用 CCB+噻嗪类的患者的动态收缩压和舒张压变异性显著降低。CCB+噻嗪类和 CCB+ACE 抑制剂组的 BPV 相似。使用诊所内血压和变异系数评估时，各组之间的 BPV 模式相似。
与 CCB 类药物组合相比，ACE 抑制剂加噻嗪类药物通常与更高水平的动态和诊所内收缩压和舒张压变异性相关，这些结果补充了 CREOLE 试验中这些治疗方法对动态血压降低作用的差异。
