RESUMO
Most patients inadvertently miss an occasional dose of antihypertensive therapy, and hence drugs that provide sustained blood-pressure (BP) reduction beyond the 24-h dosing interval are desirable. The primary objective of this study was to compare the 24-h mean ambulatory BP reductions from baseline after a simulated missed dose of the direct renin inhibitor aliskiren, irbesartan or ramipril. In this double-blind study, 654 hypertensive patients (24-h mean ambulatory diastolic BP (MADBP) >or=85 mm Hg) were randomized 1:1:1 to once-daily aliskiren 150 mg, irbesartan 150 mg or ramipril 5 mg. Doses were doubled after 2 weeks. At day 42, patients were again randomized equally within each group to receive 1 day of placebo ('missed dose') on either day 42 or day 49. Patients with a successful 24-h ambulatory BP measurement at baseline and on day 42/49 were included in the analyses. The 24-h mean ambulatory systolic BP (MASBP)/MADBP reductions from baseline after a missed dose of aliskiren 300 mg (9.3/7.0 mm Hg) were similar to irbesartan 300 mg (9.5/7.3 mm Hg) and significantly larger than ramipril 10 mg (7.1/5.0 mm Hg, PAssuntos
Amidas/administração & dosagem
, Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem
, Inibidores da Enzima Conversora de Angiotensina/administração & dosagem
, Anti-Hipertensivos/administração & dosagem
, Compostos de Bifenilo/administração & dosagem
, Pressão Sanguínea/efeitos dos fármacos
, Fumaratos/administração & dosagem
, Hipertensão/tratamento farmacológico
, Adesão à Medicação
, Ramipril/administração & dosagem
, Tetrazóis/administração & dosagem
, Adulto
, Idoso
, Amidas/efeitos adversos
, Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos
, Inibidores da Enzima Conversora de Angiotensina/efeitos adversos
, Anti-Hipertensivos/efeitos adversos
, Compostos de Bifenilo/efeitos adversos
, Monitorização Ambulatorial da Pressão Arterial
, Brasil
, Canadá
, Método Duplo-Cego
, Esquema de Medicação
, Europa (Continente)
, Feminino
, Fumaratos/efeitos adversos
, Humanos
, Hipertensão/fisiopatologia
, Irbesartana
, Masculino
, Pessoa de Meia-Idade
, Ramipril/efeitos adversos
, Tetrazóis/efeitos adversos
, Fatores de Tempo
, Resultado do Tratamento
RESUMO
Microalbuminuria (MA) is a well recognized marker of cardiovascular complications in hypertension, but whether MA can predict adverse outcome in this clinical condition is still a subject for debate. The fact that in hypertensive cohorts those patients who showed an increase in albumin excretion rate also manifested an increased incidence of morbid events indicates that the presence of MA in hypertension may carry an increased cardiovascular risk. However, the prognostic significance of MA remains controversial because no results of prospective studies performed in hypertensive subjects without diabetes mellitus are available. Several factors can affect the prevalence of MA in hypertension, including severity of the disease, selection procedures, concomitant risk factors, degree of obesity, age, and sex distribution. This accounts for the large differences in the prevalence of MA that can be found in the literature, with prevalence rates going from a low of 4.7% to a high of 40%. There is still conflict over whether MA in hypertension is due to increased intraglomerular pressure or to glomerular damage. The data from the literature suggest that in subjects with mild hypertension the main determinant of albumin excretion rate is the haemodynamic load. In subjects with more severe hypertension and hypertensive complications, the augmented urinary albumin leak is probably the consequence of a systemic microvascular disturbance which involves the glomeruli. In this respect, the insulin resistance state often associated to high blood pressure appears as one of the main pathogenetic factors. Whether management of hypertensive populations may be improved by monitoring of albumin excretion rate and whether antihypertensive drugs which are more effective in decreasing urinary albumin can be more beneficial in patients with MA remains to be determined.