Blood pressure (BP) control has become a leading strategy in cardiovascular preventative medicine, because hypertension is the most diffuse preventable cardiovascular risk factor. In contrast, clinic assessment of BP in the last 20 years has been widely integrated both in practice and in clinical studies by the use of 24 h ambulatory BP monitoring (ABPM). This technique provides an enormous amount of information regarding the blood pressure profile of the individual patient and, most of all, gives key information in the assessment of the efficacy of any antihypertensive treatment.
ABPM has progressively become a fundamental step in the clinical management of hypertension, although in both hypertension guidelines and routine clinical practice the use of this important technique is not completely supported and implemented. For these reasons, the present monograph is in my opinion absolutely timely in focussing on this important issue and highlighting its role in the management of hypertension in clinical practice.
The chapter on the clinical value of ABPM in assessing the antihypertensive efficacy of drug treatment has been elegantly written by one of the world’s leading experts in the field, Eoin O’Brien. It represents a valuable and thorough state-of-the-art document on the current use, recommendations, advantages, and limits of ABPM. O’Brien strongly believes that ABPM should be mandatory in future clinical trials in hypertension, as is suggested by the European Medicines Agency (EMA). In fact, looking at the data of the studies that are discussed and analyzed in this review, there is little doubt about the benefits of ABPM for testing drug efficacy in clinical trials in the field of arterial hypertension.
In the second chapter, Paolo Verdecchia provides a brilliant example of the importance of ABPM when comparing antihypertensive efficacy achieved with different treatments, with a focus on one of the newer compounds within the class of angiotensin receptor blockers (ARBs), olmesartan-medoxomil. Verdecchia initially illustrates and discusses with competence and experience a vast number of longitudinal studies in hypertension that explore the prognostic value of ABPM. He then illustrates clinical algorithms to interpret 24-h BP monitoring and, finally, carefully analyzes several studies in which the efficacy of olmesartan has been investigated using ABPM, as should be done in all new investigations. Through the analysis of these studies it appears evident that an important clinical feature of olmesartan-based therapy is the long duration of the BP-lowering effect. This action, while respecting the circadian BP trend, ensures a real 24-h antihypertensive coverage. This property is not shared by all compounds in the class of ARBs. Therefore, it appears clear how important ABPM is in testing drug efficacy in a thorough and informative way.
Both chapters are very well illustrated and referenced, and I am quite confident that physicians will find this current issue of Hot Topics in Hypertension very useful and timely in their practice.