Could Serum Urate Changes after Diuretic Therapy Predict an Elevated Cardiovascular Risk?

wrist actigraphy to accurately calculate the diurnal and nocturnal means of BP on a per subject basis. There was a highly significant BP reduction after 3 months of valsartan (P 0.001), slightly larger after bedtime dosing (13.3 and 7.1 mm Hg reduction in the 24-hour mean of systolic and diastolic BP after valsartan on awakening; 15.4 and 9.4 mm Hg when valsartan was administered at bedtime). The day/night ratio measured as the nocturnal decline of BP relative to the diurnal mean was unchanged after valsartan on awakening (-1.3 and -0.1 for systolic and diastolic BP; P 0.171). This ratio was significantly increased (7.5 and 6.8 for systolic and diastolic BP; P 0.001) when valsartan was administered at bedtime. The reduction of nocturnal mean was doubled after valsartan at bedtime as compared to morning treatment (P 0.001). Results indicate that, independently of the time of administration with respect to the restactivity cycle, a single dose of 160 mg/day of valsartan efficiently reduces BP for the whole 24 hours post-dose. In elderly hypertensive patients, mainly characterized by a diminished nocturnal decline in BP, dosing time with valsartan might be chosen at bedtime, for improved efficacy during the nocturnal resting hours, and the potential reduction in cardiovascular risk associated with a normalized day/night ratio.