Blood pressure variability over 24 h: prognostic implications and treatment perspectives. An assessment using the smoothness index with telmisartan–amlodipine monotherapy and combination

In-office blood pressure (BP) measurements have recognized limitations, including the inability to collect BP information over a long period of time, and during an individual’s usual daily activities. Home or ambulatory BP monitoring (ABPM) may therefore be used to complement conventional office measurements, thereby improving prognostic value. Of particular relevance is the ability of 24 h ABPM to quantify the degree of BP variability over 24 h, which has been shown to be a significant and independent risk factor for cardiovascular (CV) morbidity and mortality. Twenty-four hour BP variability is indeed strongly associated with clinical outcomes, and the ability of ABPM to provide a quantification of BP throughout the 24-h period during an individual’s normal daily routine is one of the reasons for its high prognostic value. The smoothness index (SI) provides a useful measure of antihypertensive treatment efficacy over the 24 h dosing period, its values being highest with antihypertensive agents that have large and consistent effects across 24 h. Telmisartan and amlodipine are long-acting antihypertensive drugs that, in combination, not only reduce 24 h mean BP more than the respective monotherapies but also provide a significantly greater SI. The provision of homogeneous 24 h BP control has important clinical implications. Maintaining smooth BP over the entire 24 h dosing period may contribute to the improvement of CV outcomes, and reductions in BP variability may decrease end organ damage, and reduce CV risk