Abnormal variations in night-time hypertension such as the non-dipping type (< 10% decrease in nocturnal systolic blood pressure [SBP] from daytime SBP) are associated with a risk for cardiovascular events independent of 24-h BP. As part of a randomized, double-blind study of azilsartan (20-40 mg once daily) and candesartan (8-12 mg once daily) in patients with essential hypertension, researchers conducted an exploratory analysis using ambulatory BP monitoring (ABPM) at baseline and week 14. They studied the effects of the drugs on nocturnal BP variations depending on the patients nocturnal SBP dipping status.

ABPM data were available for 273 patients treated with azilsartan and 275 with candesartan. In the dipping group (≥ 10% decrease from daytime SBP), azilsartan yielded a higher reduction from baseline in daytime than in night-time SBP (- 14.1 and - 10.9 mmHg, respectively). The change in daytime SBP was also significantly greater with azilsartan as compared to candesartan. In the non-dipping group, azilsartan yielded a higher reduction from baseline in night-time than in daytime SBP (- 20.2 and - 9.9 mmHg, respectively), and the reductions in both night-time SBP and daytime SBP were significantly greater with azilsartan, when compared with candesartan.

Once-daily azilsartan was thus found to be better at improving non-dipping night-time SBP than candesartan in patients with grade I-II essential hypertension. The findings were published in the journal Blood Pressure.