Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension

Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various drug therapies are used to lower peripheral blood pressure (BP) in patients with isolated systolic hypertension, the effects of the 4 major cla...

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Veröffentlicht in:Hypertension (Dallas, Tex. 1979) Jg. 54; H. 2; S. 409
Hauptverfasser: Mackenzie, Isla S, McEniery, Carmel M, Dhakam, Zahid, Brown, Morris J, Cockcroft, John R, Wilkinson, Ian B
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.08.2009
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ISSN:1524-4563, 1524-4563
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Abstract Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various drug therapies are used to lower peripheral blood pressure (BP) in patients with isolated systolic hypertension, the effects of the 4 major classes of antihypertensive agents on central BP, pulse pressure (PP) amplification, and arterial stiffness in this condition are not clear. Fifty-nine patients over the age of 60 years with untreated isolated systolic hypertension (systolic BP > or =140 mm Hg and diastolic BP <or =90 mm Hg) were randomly assigned to receive 1 of the following 4 antihypertensive agents: perindopril, atenolol, lercanidipine, or bendrofluazide. BP was measured using a mercury sphygmomanometer, and augmentation index and carotid-femoral (aortic) pulse wave velocity were measured at baseline, after 2 weeks of placebo therapy, and at the end of 10 weeks of active therapy. Peripheral systolic BP and peripheral PP were reduced similarly after treatment with all 4 classes of drug. However, central PP was only reduced significantly by perindopril, lercanidipine, and bendrofluazide, whereas atenolol had no effect. Lercanidipine reduced the augmentation index, whereas atenolol increased it. Aortic pulse wave velocity was not changed by any of the drugs. In summary, despite similar reductions in peripheral systolic and PPs with the 4 classes of drug, changes in central pressure and augmentation index varied. Because central PP and increased wave reflections are considered important risk factors in patients with isolated systolic hypertension, the choice of therapy may be influenced by these findings in the future.
AbstractList Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various drug therapies are used to lower peripheral blood pressure (BP) in patients with isolated systolic hypertension, the effects of the 4 major classes of antihypertensive agents on central BP, pulse pressure (PP) amplification, and arterial stiffness in this condition are not clear. Fifty-nine patients over the age of 60 years with untreated isolated systolic hypertension (systolic BP > or =140 mm Hg and diastolic BP <or =90 mm Hg) were randomly assigned to receive 1 of the following 4 antihypertensive agents: perindopril, atenolol, lercanidipine, or bendrofluazide. BP was measured using a mercury sphygmomanometer, and augmentation index and carotid-femoral (aortic) pulse wave velocity were measured at baseline, after 2 weeks of placebo therapy, and at the end of 10 weeks of active therapy. Peripheral systolic BP and peripheral PP were reduced similarly after treatment with all 4 classes of drug. However, central PP was only reduced significantly by perindopril, lercanidipine, and bendrofluazide, whereas atenolol had no effect. Lercanidipine reduced the augmentation index, whereas atenolol increased it. Aortic pulse wave velocity was not changed by any of the drugs. In summary, despite similar reductions in peripheral systolic and PPs with the 4 classes of drug, changes in central pressure and augmentation index varied. Because central PP and increased wave reflections are considered important risk factors in patients with isolated systolic hypertension, the choice of therapy may be influenced by these findings in the future.
Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various drug therapies are used to lower peripheral blood pressure (BP) in patients with isolated systolic hypertension, the effects of the 4 major classes of antihypertensive agents on central BP, pulse pressure (PP) amplification, and arterial stiffness in this condition are not clear. Fifty-nine patients over the age of 60 years with untreated isolated systolic hypertension (systolic BP > or =140 mm Hg and diastolic BP <or =90 mm Hg) were randomly assigned to receive 1 of the following 4 antihypertensive agents: perindopril, atenolol, lercanidipine, or bendrofluazide. BP was measured using a mercury sphygmomanometer, and augmentation index and carotid-femoral (aortic) pulse wave velocity were measured at baseline, after 2 weeks of placebo therapy, and at the end of 10 weeks of active therapy. Peripheral systolic BP and peripheral PP were reduced similarly after treatment with all 4 classes of drug. However, central PP was only reduced significantly by perindopril, lercanidipine, and bendrofluazide, whereas atenolol had no effect. Lercanidipine reduced the augmentation index, whereas atenolol increased it. Aortic pulse wave velocity was not changed by any of the drugs. In summary, despite similar reductions in peripheral systolic and PPs with the 4 classes of drug, changes in central pressure and augmentation index varied. Because central PP and increased wave reflections are considered important risk factors in patients with isolated systolic hypertension, the choice of therapy may be influenced by these findings in the future.Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various drug therapies are used to lower peripheral blood pressure (BP) in patients with isolated systolic hypertension, the effects of the 4 major classes of antihypertensive agents on central BP, pulse pressure (PP) amplification, and arterial stiffness in this condition are not clear. Fifty-nine patients over the age of 60 years with untreated isolated systolic hypertension (systolic BP > or =140 mm Hg and diastolic BP <or =90 mm Hg) were randomly assigned to receive 1 of the following 4 antihypertensive agents: perindopril, atenolol, lercanidipine, or bendrofluazide. BP was measured using a mercury sphygmomanometer, and augmentation index and carotid-femoral (aortic) pulse wave velocity were measured at baseline, after 2 weeks of placebo therapy, and at the end of 10 weeks of active therapy. Peripheral systolic BP and peripheral PP were reduced similarly after treatment with all 4 classes of drug. However, central PP was only reduced significantly by perindopril, lercanidipine, and bendrofluazide, whereas atenolol had no effect. Lercanidipine reduced the augmentation index, whereas atenolol increased it. Aortic pulse wave velocity was not changed by any of the drugs. In summary, despite similar reductions in peripheral systolic and PPs with the 4 classes of drug, changes in central pressure and augmentation index varied. Because central PP and increased wave reflections are considered important risk factors in patients with isolated systolic hypertension, the choice of therapy may be influenced by these findings in the future.
Author Brown, Morris J
Wilkinson, Ian B
McEniery, Carmel M
Cockcroft, John R
Mackenzie, Isla S
Dhakam, Zahid
Author_xml – sequence: 1
  givenname: Isla S
  surname: Mackenzie
  fullname: Mackenzie, Isla S
  organization: Clinical Pharmacology Unit, Addenbrooke's Hospital Box 110, Cambridge, CB2 0QQ United Kingdom
– sequence: 2
  givenname: Carmel M
  surname: McEniery
  fullname: McEniery, Carmel M
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  givenname: Zahid
  surname: Dhakam
  fullname: Dhakam, Zahid
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  givenname: Morris J
  surname: Brown
  fullname: Brown, Morris J
– sequence: 5
  givenname: John R
  surname: Cockcroft
  fullname: Cockcroft, John R
– sequence: 6
  givenname: Ian B
  surname: Wilkinson
  fullname: Wilkinson, Ian B
BackLink https://www.ncbi.nlm.nih.gov/pubmed/19487582$$D View this record in MEDLINE/PubMed
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Snippet Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various...
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StartPage 409
SubjectTerms Administration, Oral
Aged
Analysis of Variance
Antihypertensive Agents - administration & dosage
Arteries - drug effects
Arteries - physiopathology
Atenolol - administration & dosage
Bendroflumethiazide - administration & dosage
Blood Pressure Determination - methods
Dihydropyridines - administration & dosage
Dose-Response Relationship, Drug
Double-Blind Method
Drug Administration Schedule
Elasticity - drug effects
Female
Follow-Up Studies
Hemodynamics - drug effects
Hemodynamics - physiology
Humans
Hypertension - diagnosis
Hypertension - drug therapy
Male
Middle Aged
Multivariate Analysis
Patient Compliance
Perindopril - administration & dosage
Probability
Regression Analysis
Risk Assessment
Systole - drug effects
Systole - physiology
Treatment Outcome
Title Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension
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