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Valsartan May Produce Lower Ambulatory Heart Rate, Greater Lowering of Daytime Systolic Blood Pressure than Amlodipine in Elderly Patients with Systolic Hypertension

Results from a new study suggest that valsartan and amlodipine, either as monotherapy or in combination with hydrochlorothiazide, can produce sustained 24-hour blood pressure control in elderly patients with systolic hypertension. However, valsartan may produce a lower ambulatory heart rate and a greater lowering in daytime systolic blood pressure.

Evidence has shown that ambulatory blood pressure (BP) is a better predictor of hypertension-related complications than office BP. This finding may be particularly important for elderly subjects with isolated systolic hypertension, because excessive BP variability, absence of nocturnal dipping, and postural and postprandial hypotension have been frequently detected in these patients.

"This raises the question as to whether, and to what extent, anti-hypertensive treatment modifies their BP profiles during everyday life," writes Paolo Palatini, MD, of the University of Padova, Italy.

Dr. Palatini and colleagues performed a study to compare the time-effect profiles of valsartan, an angiotensin II receptor blocker, and amlodipine, a dihydropyridine calcium channel blocker, in terms of ambulatory BP and heart rate in 164 elderly patients with systolic hypertension. The analysis was performed as a sub-study of the Val-Syst trial, which previously found that valsartan and amlodipine are both highly effective in controlling office BP.

After a 2-week washout period, 79 patients in the double-blind study were randomised to receive 80 mg valsartan (mean age=69.2, 39 males) and 85 to receive 5 mg amlodipine (mean age=69.1, 46 males). The dosages were doubled after 8 weeks of treatment if adequate BP control (trough office systolic < 140 mm Hg) was not achieved. If systolic BP remained poorly controlled at 16 weeks from baseline, low-dose hydrochlorothiazide (12.5mg) was added for an additional 8 weeks. 24-hour ambulatory recordings were performed after the placebo period and at the end of active treatment.

Both valsartan and amlodipine lowered mean 24-hour daytime and night time systolic BP (P < .001 for all) without any significant differences between the two regimens. However, ambulatory heart rate decreased in the patients on valsartan and slightly increased in those on amlodipine (between-group differences; 24h, P = .009; daytime, P = .002; night-time, not significant).

Among the responders to therapy (valsartan, n=67; amlodipine, n=71), valsartan induced a significantly greater lowering in daytime systolic BP (-20.4+/-12.1 mm Hg vs. -16.6+/-9.7 mm Hg, p=0.02) and average 24-hour systolic BP (-18.3+/-10.4 mm Hg vs. -15.0+/-9.3 mm Hg, P = .02) compared with amlodipine. No significant differences were detected between the mean-night-time BP fall, mean systolic BP/trough ratios (valsartan, 0.56; amlodipine, 0.77), or smoothness index (valsartan, 1.70; amlodipine, 1.58).

"Valsartan-based treatment compared favourably with amlodipine-based treatment because of its greater day-time systolic BP lowering effect in responders, and its favourable effect on ambulatory heart rate," the researchers conclude.



Blood Press Monit 2004 Apr;9:2:91-97. "Comparison of the effects on 24-h ambulatory blood pressure of valsartan and amlodipine, alone or in combination with a low-dose diuretic, in elderly patients with isolated systolic hypertension (Val-syst Study)"

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