Fimasartan for independent reduction of blood pressure variability in mild-to-moderate hypertension

Mi-Seung Shin,¹ Dae Ryong Kang,² Changsoo Kim,³ Eun Joo Cho,⁴ Ki-Chul Sung,⁵ Seok-Min Kang,⁶ Dong-Soo Kim,⁷ Seung Jae Joo,⁸ Seung Hwan Lee,⁹ Kyung-Kuk Hwang,¹⁰ Jeong Bae Park<sup>11

1</sup>Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, ²Office of Biostatistics, Ajou University School of Medicine, Suwon, ³Department of Preventive Medicine, Yonsei University College of Medicine, ⁴Division of Cardiology, Department of Internal Medicine, St Paul’s Hospital, Catholic University of Korea, ⁵Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, ⁶Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, ⁷Division of Cardiology, Paik Hospital, Inje University College of Medicine, Busan, ⁸Division of Cardiology, Jeju National University Hospital, Jeju, ⁹Division of Cardiology, Wonju Severance Christian Hospital, Wonju Medical College, Yonsei University, Wonju, ¹⁰Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, ¹¹Division of Medicine/Cardiology, Department of Internal Medicine, Cheil General Hospital, Dankook University College of Medicine, Seoul, South Korea

Background: The angiotensin receptor antagonist fimasartan lowered blood pressure (BP) in a previous large population study. The purpose of this study was to evaluate whether fimasartan treatment for 3 months affects clinical and home BP variability in addition to reducing BP.
Methods: The study enrolled 1,396 patients (mean age 56.2±10.0 years; males 53.6%) with mild-to-moderate hypertension who had a complete set of home BP measurements (morning and evening) and metabolic risk evaluation. During the 3 months of study, fimasartan alone was used to control BP at a daily dose of 30–120 mg. Clinical and home BP measurements were performed before and after the 3-month treatment. BP variability included beat-to-beat variability (clinical) and day-to-day variability (home).
Results: Fimasartan reduced BP after 3 months of treatment. The average reduction of clinical systolic BP (c-SBP) was 15.08±18.36 mmHg (P<0.0001), and the average reduction of morning home SBP (m-SBP) was 11.49±19.33 mmHg (P<0.0001). Beat-to-beat variability as standard deviation (SD) of c-SBP was reduced from 4.56±3.22 to 4.24±3.11 mmHg (P=0.0026). Day-to-day variability as SD of m-SBP was reduced from 7.92±6.74 to 6.95±4.97 mmHg (P<0.0001). Multiple regression analysis revealed an independent association between the change in the SD of c-SBP and the change in c-SBP (P=0.0268) and, similarly, between the change in the SD of m-SBP and the change in m-SBP (P=0.0258), after adjusting for age, sex, body mass index, and change in mean BP.
Conclusion: This study indicated that 3 months of fimasartan treatment reduced day-to-day BP variability independent of BP reduction in patients with hypertension.

Keywords: angiotensin receptor blockers, hypertension, blood pressure variability