P-171: Effects of perindopril on 24-h blood pressure in hypertensive patients with diabetic nephropathy

• Published in: American journal of hypertension Vol. 17; no. S1; p. 95A
• Main Authors: Yasuda, Gen, Ogawa, Nariaki, Shimura, Gaku, Ando, Daisaku, Shibata, Kazuhiko, Umemura, Satoshi, Tochikubo, Osamu
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2004
• Subjects: Ambulatory Blood Pressure; Angiotensin Converting Enzyme Inhibitor; Sympathovagal Balance
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2004.03.246

Effects of angiotensin converting enzyme inhibitors (ACEI) on 24-h blood pressure (BP) changes in hypertensive patients with diabetic nephropathy have not yet been fully evaluated. We assessed the effects of an ACEI, perindopril (4 mg/day), on 24-h BP in these patients (serum creatinine concentration <2 mg/dL) using an ambulatory BP monitoring device. We also analyzed the power spectrum of heart rate variability to evaluate autonomic nervous activity. High frequency component (HF), an index of parasympathetic nervous activity, and low frequency component (LF)/HF ratio, an index of sympathovagal balance, were calculated. Patients were divided into two groups (dipper, mean sleeping/waking systolic BP ratio <0.9, n=16; nondipper, mean sleeping/waking systolic BP ratio ≥0.9, n=18). In the dipper group, the mean waking BP were 158 ± 13 (SD)/88 ± 9 mmHg, which decreased to 146 ± 15/80 ± 9 mmHg (P<0.05) after 3–6 months of perindopril treatment. However, there were no changes in the mean sleeping BP before (136 ± 13/75 ± 8 mmHg) and after (132 ± 13/71 ± 8 mmHg) treatment. In the nondipper group, on the other hand, significant decreases (P<0.05) of both waking (161 ± 11/88 ± 8 mmHg to 154 ± 15/83 ± 10 mmHg) and sleeping BP (155 ± 12/83 ± 9 mmHg to 143 ± 13/74 ± 11 mmHg) were observed after perindopril treatment. In both groups, HF components did not change before and after perindopril treatment (15.6 ± 6.4 vs 16.1 ± 8.5 during waking and 20.1 ± 9.1 vs 19.6 ± 8.8 during sleeping in the dipper group; 15.4 ± 6.1 vs 15.0 ± 7.1 during waking and 18.9 ± 7.2 vs 19.1 ± 8.8 during sleeping in the nondipper group). During waking, the LF/HF ratios decreased (P<0.05) from 2.2 ± 0.5 to 1.8 ± 0.4 in the dipper group and from 2.2 ± 0.5 to 1.7 ± 0.4 in the nondipper Group. During sleeping, however, these ratios decreased significantly (P<0.05) from 1.7 ± 0.6 to 1.4 ± 0.5 only in the nondipper group. Our findings suggest that perindopril decreases sleeping BP as well as waking BP through changing sympathovagal balance in the nondippers among hypertensive patients with diabetic nephropathy. Am J Hypertens (2004) 17, 95A–95A; doi: 10.1016/j.amjhyper.2004.03.246