Duration of Action as an Important Characteristic of Antihypertensive Drugs

Authors: Rainer Düsing
Authors‘ workplace: Medizinische Klinik und Poliklinik Bonn, Nemecko
Published in: Forum Diab 2013; 2(1): 11-17
Category: Topic


A variety of drugs are available for the treatment of hypertension. They have traditionally been characterized by their mode of action, e.g. diuretics, ACE-inhibitors, angiotensin receptor antagonists, calcium channel blockers. Despite marked differences in the mechanisms decreases in blood pressure (BP), their prognostic effects appear to be similar. This has led to the consensus that BP lowering itself is the main mediator of the cardiovascular protection provided by antihypertensive therapy. Duration of action may be another important aspect to characterize antihypertensive drugs. Most of the available medication to be taken once daily will sufficiently lower BP for a 24 hour period. However, non-compliance with antihypertensive therapy may markedly prolong the dosing interval when medication time points are delayed or even missed. In clinical trials with electronic medication monitoring, about 10% of the scheduled doses were omitted on any given day, almost half of those omissions being part of a sequence of several days. In the common scenario of a prolonged dosing interval drugs with prolonged efficacy act as forgiving drugs in the sense that therapeutic coverage is provided in spite of irregular intake. The present review focusses on this important aspect of antihypertensive therapy and points to the fact that besides the thiazide-type diuretic chlorthalidone and the calcium channel blocker amlodipine the direct renin inhibitor aliskiren is also characterized by prolonged efficacy and thus, forgiveness.

Key words:
aliskiren – antihypertensive drugs – compliance – duration of action – forgiveness


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