Ambulatory Blood Pressure Monitoring in the Prediction of Cardiovascular Events and Effects of Chronotherapy
Prognostic Value of Ambulatory Blood Pressure Monitoring in the Prediction of Cardiovascular Events and Effects of Chronotherapy in Relation to Risk (the MAPEC Study).
  • Phase

    Phase 4
  • Study Type

  • Status

    Completed No Results Posted
  • Study Participants

The MAPEC study was designed to investigate whether normalizing the circadian blood pressure profile towards a more dipper pattern (increasing the diurnal/nocturnal ratio of blood pressure) by the use of Chronotherapy (that is, taking into account the time of day of administration of antihypertensive medications) reduces cardiovascular risk.
Target organ damage is more closely associated with ambulatory (ABPM) than with clinic blood pressure (BP). In particular, the reduction of the normal 10 to 20% sleep-time BP decline (non-dipper pattern) is associated with elevated risk of end-organ injury, particularly to the heart, brain and kidney. These results suggest that cardiovascular risk could be influenced not by BP elevation alone, but also by the magnitude of the circadian BP variability. Moreover, at least two independent prospective studies have suggested that nighttime BP is a better predictor of risk than daytime BP. Common to all previous trials is that prognostic significance of ABPM has relied on a single baseline profile from each participant, without accounting for possible changes in the BP pattern, mainly associated to antihypertensive therapy and aging during follow-up. The MAPEC study investigates, first, the comparative prognostic value of several BP parameters (including, among many others, BP variability, the diurnal/nocturnal ratio, diurnal and nocturnal means, slope of morning rise, etc) in the prediction of cardiovascular morbidity and mortality; and, second, whether potential changes in the circadian BP pattern after Chronotherapy with antihypertensive drugs are associated to changes in cardiovascular risk.
Study Started
Mar 31
Primary Completion
Apr 30
Study Completion
Apr 30
Last Update
Apr 28

Device Ambulatory blood pressure monitoring

Sampling at 20-min intervals from 07:00 to 23:00 hours and at 30-min intervals at night for 48 consecutive hours

Procedure Chronotherapy, timing of antihypertensive medication

Comparison of effects of awakening versus bedtime dosing

Drug ACEI (including spirapril, enalapril, quinapril, lisinopril)

Treatment at awakening versus bedtime

Drug ARB (including valsartan, telmisartan, olmesartan)

Treatment at awakening versus bedtime

Drug beta blockers (including nebivolol, atenolol, carvedilol)

Treatment at awakening versus bedtime

Drug diuretics (torasemide, indapamide, HTCZ) and doxazosin

Treatment at awakening versus bedtime

Procedure Combination therapy in essential hypertension

Treatment at awakening versus bedtime


Inclusion Criteria:

Essential hypertension

Exclusion Criteria:

shift workers
secondary hypertension
intolerant to ABPM
No Results Posted