Comparison of valsartan and amlodipine on ambulatory and morning blood pressure in hypertensive patients

Abstract Background Cardiovascular events occur most frequently in the morning. We aimed to study the effects of monotherapy with the long-acting angiotensin II receptor blocker valsartan compared with the long-acting calcium antagonist amlodipine on ambulatory and morning blood pressure (BP). Methods We performed ambulatory BP monitoring before and after once-daily dose of valsartan (valsartan group, n = 38) and amlodipine (amlodipine group, n = 38) therapy in 76 hypertensive patients. To achieve the target BP of ≤140/90 mm Hg, valsartan was titrated from 40 mg/day to 160 mg/day (mean dose 124 mg/day) and amlodipine was titrated from 2.5 mg/day to 10 mg/day (mean dose 6.4 mg/day). Results Both drugs significantly reduced clinic and 24-h systolic BP (SBP) and diastolic BP (DBP) (P< .002). However, the antihypertensive effect of amlodipine was superior to that of valsartan in clinical SBP (−26 mm Hg v −13 mm Hg, P = .001) and 24-h SBP (−14 mm Hg v −7 mm Hg, P = .008). In addition, morning SBP was significantly reduced by amlodipine from 156 to 142 mm Hg (P< .001) but not by valsartan. Both agents reduced lowest night SBP to a similar extent (amlodipine 121 to 112 mm Hg, P< .001; valsartan 123 to 114 mm Hg, P< .002). Reduction in morning SBP surge (morning SBP minus lowest night SBP) was significantly greater in patients treated with amlodipine compared with those treated with valsartan (−6.1 mm Hg v +4.5 mm Hg, P< .02). Conclusions Amlodipine monotherapy was more effective than valsartan monotherapy in controlling 24-h ambulatory BP and morning BP in hypertensive patients.