New FDA guidelines on the treatment of hypertension: comparison of different therapeutic classes according to trough/peak blood pressure responses

The FDA guidelines, recommending a trough/peak blood pressure response ratio of at least 50%, were formulated with a view to providing a definitive index of duration of action of an antihypertensive drug. The aim was to prevent the use of drug regimens that utilised high doses of drug with the aim of maintaining a significant reduction in blood pressure at the end of the steady state dosage interval. The calculation of trough/peak ratios is subject to significant variability but much of this can be directly attributed to different methodological approaches. However, when conditions are standardised it has been shown that trough/peak ratios are reproducible in individual patients. Trough/peak ratios defined for different antihypertensive drugs often exhibit as many differences within a therapeutic class as between therapeutic classes. Thus there is no single therapeutic class of drugs that offers high trough/peak ratios compared to an alternative class. The possible exception to this are the diuretics which probably all have comparatively high trough/peak ratios although this has never formally been defined. With respect to the beta adrenoceptor antagonists there is discernible discrimination between the once a day agents with betaxolol, bisoprolol and acebutolol all having a longer duration of action as defined by a higher trough/peak response than atenolol. Calcium antagonists show considerable variability in trough/peak ratio between different drugs. In particular the first generation agents, verapamil, nifedipine and diltiazem all had relatively low values. Not all the second generation agents were superior to this and at present only amlodipine and lacidipine and some of the "reformulated" agents meet the recommendations of the Guidelines for once a day drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Published by Archives des maladies du coeur et des vaisseaux, 1994. The guideline itself is at the source linked here.

pubmed.ncbi.nlm.nih.gov/7771888/