A plea for more comprehensive blood pressure measurements when evaluating drug treatment of hypertension

Blood pressure was studied at rest, continuously for 24 h and during dynamic and isometric exercise in previously untreated males with documented mild hypertension. The antihypertensive efficacy of atenolol was compared with that of enalapril in a randomized, double-blind, crossover study, in order to elucidate whether or not these more comprehensive measurements could better distinguish between the efficacy of the drugs than office recordings made at rest. Atenolol proved more effective than enalapril in reducing diastolic blood pressure at rest (P < 0.05), and systolic blood pressure during dynamic exercise (P < 0.001), but in the 24-h ambulatory study there were no differences in effectiveness between the drugs. Several patients did not attain our pre-set diastolic treatment goal at rest (≤ 90mmHg) on single-drug therapy, thus indicating a need for supplementary treatment. When blood pressure was analysed over 24 h, however, there were few recordings > 90mmHg, and the need for supplementary treatment appeared less obvious. Therefore, more comprehensive blood pressure measurements should be considered in the evaluation of antihypertensive treatment