Application of ambulatory blood pressure monitoring to clinical therapeutic decisions in hypertension

The antihypertensive efficacies of lisinopril and captopril were compared using office sphygmomanometry and 24-h ambulatory blood pressure monitoring. In a double-blind, prospective, randomly allocated trial, the patients were given increasing doses of captopril at 25-100 mg twice a day or lisinopril at 10-40 mg once a day until a clinical response was achieved or the highest dose was reached. A response was defined as a reduction in diastolic pressure below 90 mmHg or a fall of at least 10 mmHg from baseline. The ambulatory monitoring showed that lisinopril reduced blood pressure from baseline to the final value and maintained the reduction to a greater degree than captopril throughout 24-h periods of observation. The office measurements showed a similar trend, but the intertreatment differences did not reach statistical significance. No first-dose side effects were observed with either drug. Once a day lisinopril appeared to be a more effective antihypertensive regimen than twice a day captopril.