As nearly half of hypertensive patients are those with morning hypertension, treatment targeting Vadimezan morning hypertension (as assessed by measuring ME average and ME difference) should be added to standard therapy [5]. Regarding the changes in patient distribution based on ME average and ME difference, in this investigation the proportion of patients classified as having normal BP increased significantly from 5.7 % to 42.8 %, which was higher than the value of 37.9 % reported in the J-MORE Study [13]. Of the patients with morning-predominant hypertension at baseline, 35.0 % were classified as having

normal BP at the endpoint. The proportion of patients who achieved ME average of <135 mmHg increased from 8.5 % to 49.3 % after azelnidipine treatment. The proportion of those who achieved ME difference of <15 mmHg also increased from 76.8 % to 85.6 %, which was higher than the value of 74.9 % reported in the J-MORE Study [13]. Scatter plots of the patient distribution based on ME average and ME difference before and after treatment also demonstrated that azelnidipine treatment was associated with an obvious tendency toward normalization of BP in terms of both ME average and ME difference. It was inferred from these findings that azelnidipine suppresses the morning BP surge because its BP-lowering effect persists until the morning of the following day, i.e., for 24 h. The treatment of morning hypertension

may include a combination of nonspecific and specific approaches, Crenolanib nmr according to the morning BP levels [5]. In nonspecific treatment, long-acting antihypertensive drugs are used in principle, and the goal is to achieve an ME average of 135 mmHg or lower by using long-acting calcium antagonists or diuretics. On the other hand, in specific treatment, the goal is to decrease

ME difference to 15–20 mmHg or lower by evening dosing with renin-angiotensin system inhibitors or α-blockers, old or by using calcium antagonists, which have a pulse rate-lowering effect [5]. ME difference has been reported to correlate significantly with the left ventricular mass index in hypertensive patients who have never been treated for this condition or who have recently been treated with long-acting antihypertensive drugs, and it is thought to be an important risk factor for left ventricular hypertrophy [6, 16]. Azelnidipine, a long-acting calcium antagonist with a pulse rate-lowering effect, decreased ME average and ME difference significantly in the present study. On the basis of these findings, azelnidipine seems to be useful for treating morning hypertension by exerting the combined effects of specific and nonspecific treatment. In addition, this drug may be expected to improve left ventricular hypertrophy by decreasing ME difference. At present, the most common therapy for hypertension is long-acting antihypertensive drugs given once daily.