Morning hours riskiest for MI and stroke, more than half well-controlled hypertensive patients unknowingly at risk
In order to achieve tighter blood pressure control, especially during the critical early morning period, it was suggested that anti-hypertensive agents that provide sustained blood pressure control throughout the dosing interval should confer benefit in terms of cardiovascular protection.
Data presented during the 14th European Society of Hypertension meeting in Paris, however revealed that some anti-hypertensive agents do not protect patients against the increased risk of early morning cardiovascular events, such as myocardial infarction.
This was evidenced by results that showed the longest acting angiotensin ll receptor blocker (ARB) telmisartan5 provides superior sustained blood pressure control throughout the 24 hour dosing interval compared with valsartan or losartan.6,7,8,9
The superior blood pressure control of telmisartan (Micardis®) included this critical morning period - potentially providing patients with added protection against morbid or fatal cardiovascular events.
"Currently, the awareness and treatment of blood pressure for the critical early morning period is sub-optimal. This together with poor patient compliance is a major barrier in achieving adequate blood pressure control - which ultimately puts patients at high risk of cardiovascular events.
This highlights the need for anti-hypertensive agents that can provide sustained blood pressure control even if a dose is missed," commented Professor Yves Lacourcière, Director of the Hypertension Research Unit, Centre hospitalier de l´Université Laval, Canada.
Professor Lacourcière, presented data8 from the imminently to be published MICADO l & ll pooled analysis of telmisartan 80mg versus valsartan 160mg. Results showed8 that telmisartan 80mg which has a half-life of 24 hours, 5 provided more sustained blood pressure control than valsartan 160mg, which has an intermediate half-life of 7 hours.10,11
This was particularly evident during the last 6 hours of the dosing interval when incidences of blood pressure-related complications are at their highest.2 Even when a dose was missed, telmisartan (Micardis®) provided superior blood pressure control compared with valsartan for up to 48 hours after an active dose.8
"These findings demonstrate that even poorly compliant patients prescribed telmisartan would still retain acceptable levels of blood pressure control right through to their next dose including the risky early morning period of the second day compared with patients prescribed valsartan," added Professor Lacourcière.
The results of MICADO l & ll concurs with current ESH / ESC and J NC Vll Guidelines that recommend the use of long-acting, once-daily agents that provide sustained 24 hour blood pressure control to provide greater protection against cardiovascular events.
The guidelines also acknowledge that in most hypertensive patients more than one agent is needed to achieve blood pressure goals.
The recommendation suggests that agents are given either separately or in fixed-dose combinations, one of which should be a thiazide-type diuretic.12,13
Results of Combination Therapy
Using combination therapy to achieve controlled blood pressure was explored in a study presented at the ESH meeting comparing telmisartan/hydrochlorothiazide (Micardis Plus®) to losartan/hydrochlorothiazide. Results of the study showed that telmisartan/hydrochlorothiazide provides superior blood pressure control to losartan/hydrochlorothiazide during the last 6 hours of the dosing interval and is more effective in attenuating the early morning blood pressure surge.9
"Achieving blood pressure control, especially during the critical early morning hours, is an important challenge for physicians and should be considered in drug selection when managing hypertensive patients. This study demonstrates differences in blood pressure control when comparing telmisartan and losartan during the critical final 6 hours of the dosing interval, which coincides with the early morning surge in blood pressure.
This is clinically very important, as recent outcomes studies have clearly demonstrated, inadequate control of blood pressure during the early morning surge is associated with significant increases in the incidence of morbid or fatal cardiovascular events," commented by Professor Joel Neutel, Associate Professor of Medicine, University California Irvine, Director of Research, Orange County Research Center, Orange, CA, USA.
Telmisartan (Micardis®) is the only ARB to demonstrate sustained 24 hour control which is consistently superior to other commonly used anti-hypertensives.5 Data from a large database of telmisartan studies using ambulatory blood pressure monitoring (ABPM) show that telmisartan produces significantly greater reductions in mean ambulatory blood pressure in the last 4-6 hours of the dosing interval than the commonly-used antihypertensives valsartan, losartan or amlodipine.14-18
Further evidence of telmisartan's sustained 24 hour control are expected later this year when the results of the PRISMA trials are announced. PRISMA compares 24 hour blood pressure control provided by telmisartan compared to the ACE inhibitor, ramipril.
Telmisartan (Micardis®) is currently being investigated in the most ambitious and far-reaching research programme ever conducted with an ARB, with more than 53,000 patients. The ONTARGETTM Trial Programme, the PRoFESS® trial and the PROTECTIONTM trial programme aim to show reduction in cardiovascular morbidity and mortality, secondary stroke prevention and end organ protection.
Boehringer Ingelheim
The Boehringer Ingelheim Group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 152 affiliates in 45 countries and more than 34,000 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.
In 2003, Boehringer Ingelheim posted net sales of 7.4 billion euro while spending more than one fifth of net sales in its largest business segment Prescription Medicines on research and development.
Telmisartan (Micardis®)
Telmisartan was discovered and developed by Boehringer Ingelheim, Germany. Boehringer Ingelheim markets telmisartan under the trademark Micardis® in 84 countries around the world, including the USA, Japan and major European countries.
Telmisartan is also marketed in some countries by Abbott Laboratories, Bayer AG, GlaxoSmithKline, and Yamanouchi.
Notes to editor:
a) MICADO - MICArdis® Missed DOse Study
i. MICADO l - 45 centres in Europe and South Africa
ii. MICADO ll - 34 centres in USA and Canada
b) ESH / ESC Guidelines - European Society of Hypertension / European Society of Cardiology Guidelines for the management of arterial hypertension
c) JNC Vll Guidelines - The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure
d) PRISMA - A Prospective Randomised Investigation of the Safety and efficacy of Micardis vs. Ramipril using ABPM
e) ONTARGETTM - ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial
f) PRoFESS® - Prevention Regimen For Effectively avoiding Second Strokes
g) PROTECTIONTM - Programme of Research tO show Telmisartan End-organ proteCTION
h) ARB - Angiotensin II Receptor Blocker
i) ACE inhibitor - Angiotensin Converting Enzyme inhibitors
Contact:
Boehringer Ingelheim GmbH
Corporate Division Communications
Julia Meyer-Kleinmann
55216 Ingelheim am Rhein
GERMANY
Phone: +49/6132/77 82 71
Fax: +49/6132/77 66 01
References:
1. Neutel J et al. Curr Opin Nephrol Hypertens 1997;6:250-256.
2. White W. Blood Press Monit 1997;2:47-51.
3. Kario K et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives. A prospective study. Circulation 2003;107:1401-1406
4. Ishikawa J et al. Morning hypertension is masked in well-controlled hypertensives: the JICHI morning hypertension research study (J-MORE) study. Poster presented at American Society of Hypertension, 2004 New York USA
5. Burnier M et al. Angiotensin ll receptor agonists. Lancet. 2000;355:637-645.
6. Krzesinksi J et al. The antihypertensive efficacy of telmisartan versus valsartan in patients with mild-to-moderate hypertension after missing one dose. Poster presented at European Council for Blood Pressure and Cardiovascular Research 2003, Seeheim Germany
7. White W et al. Effects of angiotensin ll receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure. Am J Hypertens 2004;17:347-353.
8. Lacourcière Y et al. Sustained antihypertensive activity of telmisartan vs valsartan. In press 2004
9. Neutel J et al. Telmisartan 40 or 80mg / HCTZ 12.5mg provide superior ambulatory BP reductions compared to losartan 50 mg / HCTZ 12.5 mg during the last 6 hours of the dosing interval. Poster presented at European Society of Hypertension, 2004 Paris France
10. Markham A et al. Valsartan. A review of its pharmacology and therapeutic use in essential hypertension. Drugs 1997;54:299-311
11. Flesch G et al. Absolute bioavailability and pharmacokinetics of valsartan, an angiotensin ll receptor agonist, in man. Eur J Clin Pharmacol 1997;52:115-120
12. 2003 European Society of Hypertension - European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011 ¿ 1053
13. Jones D et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and evidence from new hypertension trials. Hypertension 2004;43(1):1-3. 2004.
14. Neutel J et al. Evaluation of ARBs for 24 hour BP control: meta-analysis of a clinical database. J Clin Hypertens2003; 5: 58-63.
15. Littlejohn T et al. A prospective, randomised, open-label trial comparing telmisartan 80 mg with valsartan 80 mg in patients with mild to moderate hypertension using ambulatory blood pressure monitoring. Can J Cardiol 2000;16:1123-1132
16. Smith D et al. Comparison of telmisartan versus losartan: meta-analysis of titration-to-response studies. Blood Press Monit 2003;8:111-117.
17. Neutel J. Use of ambulatory blood pressure monitoring to evaluate the selective angiotensin ll receptor antagonist, telmisartan, and other antihypertensive drugs. Blood Press Monit 2000;5 (suppl 1):S35-S40.
18. Lacourcière Y et al. A comparison of efficacies and duration of action of the angiotensin ll receptor blockers telmisartan and amlodipine. Blood Press Monit 1998;3:295-302.
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Buna dimineata orã riskiest pentru MI ºi accident vascular cerebral, mai mult de jumãtate bine controlate la pacienþii hipertensivi fãrã risc - Morning hours riskiest for MI and stroke, more than half well-controlled hypertensive patients unknowingly at risk - articole medicale engleza - startsanatate