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  • Title: [Circadian rhythm of arterial pressure and use of amlodipine in primary hypertension].
    Author: Spritzer N.
    Journal: Arq Bras Cardiol; 1993 May; 60(5):361-7. PubMed ID: 8311755.
    Abstract:
    PURPOSE: To evaluate the anti hypertensive efficacy and tolerability of amlodipine given once daily either morning and evening doses. METHODS: Fifty hypertensive patients were admitted into an open non comparative 18 weeks study. All patients were submitted to wash out period of 2 weeks. Afterwards, those with BP inclusion criteria started 5 mg amlodipine, which was titrated until a maximum of 10 mg. Upon reaching the ideal dosage, patients were kept 8 weeks with drug given at 8:00 am and then 8:00 pm. RESULTS: The majority of patients (60%) needed only 5 mg and 24 hours data revealed the following mean systolic BP: V2 (final of wash-out) = 149.3 +/- 4.8; V3 (morning dose) = 150.4 +/- 3.8; V4 (night dose) = 134.1 +/- 2.9; V5 (final of the study) = 129.5 +/- 6.1 (ANOVA p = 0.000; Bonferroni test: p < 0.05; test t of Student: p = 0.13, comparing V2 (final of wash-out) with V4 (night dose) and V5 (final of study). The mean diastolic BP were V2 (final of wash-out) = 96 +/- 3.2 (morning dose) = 96.2 +/- 2.7; V4 (night dose) = 81.9 +/- 2.6; V5 (final of the study) = 77.7 +/- 7.5 (ANOVA: p = 0.000; Bonferroni test: p = < 0.05; test t: p = 0.05). The following systolic percentage over normal values were observed (140 mmHg from 7:00 am to 11:00 pm; 130 mmHg from midnight to 7:00 am): V2 (final of wash-out) = 73.3% during the day and 71.1% at night; V3 (morning dose) = 76% in the morning and 75.6% at night; V4 (night dose) = 29.3% during the day and 39.3% at night; 20.9% during the day and 23% at night. Considering the limits of diurnal diastolic BP 90 mmHg and nocturnal, 80 mmHg, the following percentage of readings over normal limits were observed: V2 (final of wash-out) = 77.8% during the day and 91.8% at night; V3 (morning dose) = 80% during the day and 92.6% at night; V4 (night dose) = 6.7% during the day and 15.6% at night. Three patients presented adverse events, which disappeared spontaneously and discontinuation of treatment was not necessary. CONCLUSION: Amlodipine was considered effective and well tolerated and the majority of patients needed only 5mg daily and no reflex tachycardia was observed. Amlodipine effectively reduced BP throughout 24 h and the circadian rhythm kept unaltered and the evening administration led to a greater nocturnal fall than the morning administration. The remaining periods did not show differences.
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