Different influences on central and peripheral pulse pressure, aortic wave reflections and pulse wave velocity of three different types of antihypertensive drugs

Abstract

Objective: To evaluate in hypertensive patients (pts) with similar peripheral blood pressure (BP) whether different antihypertensive treatments have different influences on aortic stiffness, aortic central pressures and aortic wave reflections.

Methods: In a cross-over study 41 nondiabetic hypertensives (21 women, age 35-60 yrs) were evaluated after stabilized (> 4 months) antihypertensive treatment and with casual BP between 130/80 and 160/95 mmHg. Patients were divided into 3 groups: Group I--12 pts all medicated with beta-blockers; Group II--14 pts all medicated with calcium channel blockers; Group III--15 pts all medicated with either angiotensin-converting enzyme inhibitors (ACEIs) (n = 8) or angiotensin II receptor blockers (ARBs) (n = 7). We evaluated casual BP and carotid-femoral pulse wave velocity (PWV). Systolic blood pressure (SBP) and pulse pressure (PP), left ventricular ejection duration (LVED), augmentation pressure (delta P) and augmentation index (AI%) in the aorta (a measure of aortic wave reflection), derived using radial and carotid applantation tonometry, were measured. Data are means + SEM.

Results: For similar casual peripheral BP values, group III vs. group I showed lower (p < 0.05) values of: aortic stiffness--PWV (10.3 +/- 0.2 vs. 11.2 +/- 0.3 m/s), central PP (48 +/- 2 vs. 55 +/- 2 mmHg), delta TP (11 +/- 3 vs. 21 +/- 3 mmHg), LVED (297 +/- 5 vs. 319 +/- 8 ms), AI% (22 +/- 4 vs. 39 +/- 3%), suggesting reduced vascular tone in the arteries and greater brachial-aortic PP amplification. Data in group II did not differ significantly from the other two groups.

Conclusions: Independently of casual BP values, the three classes of antihypertensive drugs appear to have different influences on aortic stiffness, central pressures and aortic wave reflections, ACEIs or ARBs appearing to exhibit a more favorable profile.