Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial

Abstract

Abstract-Pulse pressure has been more strongly associated with cardiovascular outcomes, especially myocardial infarction and heart failure, than has systolic, diastolic, or mean arterial pressure in a variety of populations. Little is known, however, of the comparative effects of various classes of antihypertensive agents on pulse pressure. In retrospective analyses of the Veterans Affairs Single-Drug Therapy for Hypertension Study, we compared changes in pulse pressure with 6 classes of antihypertensive agents: 1292 men with diastolic blood pressure of 95 to 109 mm Hg on placebo were randomized to receive hydrochlorothiazide, atenolol, captopril, clonidine, diltiazem, prazosin, or placebo. Drug doses were titrated to achieve a goal diastolic blood pressure of Ͻ90 mm Hg during a 4-to 8-week medication titration phase. Pulse pressure change (placebo subtracted) was assessed from baseline to the end of the 3-month titration and 1-year maintenance. Mean baseline systolic, diastolic, and pulse pressures were 152, 99, and 53 mm Hg, respectively. Reductions in pulse pressure during titration were greater (PϽ0.001) with clonidine (6.7 mm Hg) and hydrochlorothiazide (6.2 mm Hg) than with captopril (2.5 mm Hg), diltiazem (1.6 mm Hg), and atenolol (1.4 mm Hg); reduction with prazosin (3.9 mm Hg) was similar to all but clonidine. After 1 year, pulse pressure was reduced significantly more (PϽ0.001) with hydrochlorothiazide (8.6 mm Hg) than with captopril and atenolol (4.1 mm Hg with both); clonidine (6.3 mm Hg), diltiazem (5.5 mm Hg), and prazosin (5.0 mm Hg) were intermediate. These data show that classes of antihypertensive agents differ in their ability to reduce pulse pressure. Whether these differences affect rates of cardiovascular events remains to be determined. Key Words: pulse pressure Ⅲ antihypertensive agents Ⅲ drug therapy Ⅲ human P ulse pressure (PP) has usually been found to be a stronger independent predictor of cardiovascular events, particularly in older populations, than has systolic (SBP), diastolic (DBP), or mean arterial pressure. 1-9 Although treatment of elevated DBP 10,11 or isolated SBP 10 -13 with antihypertensive agents has been shown to reduce cardiovascular events in prospective randomized controlled trials, clinical trials have not evaluated whether any reduction in cardiovascular events has been related to a reduction in PP. In fact, most studies assessing the antihypertensive efficacy of lifestyle interventions or drugs have addressed reductions in DBP and, to a limited extent, SBP. Studies have demonstrated differences in DBP and SBP antihypertensive efficacy between drug classes overall and in various demographic groups. 14 -16 Only very recently have studies begun to evaluate changes in PP, and almost no data have been published on the comparative effects of different classes of antihypertensive agents on PP. 7,17 Therefore, we compared the short-and long-term effects on changes in PP of a diuretic (hydrochlorothiazide), a ␤-blocker (atenolol), a calcium channel blocker (diltiazem sustai...

Genome-Wide Multipoint Parametric Linkage Analysis of Pulse Pressure in Large, Extended Utah Pedigrees

“…This approach assumes that medicated individuals had a minimum PP of 55 mm Hg at the time of treatment onset. This fixed value compares well with that from other studies 35,9 (53 and 62 mm Hg, respectively). In our population, 55 mm Hg corresponds to 1 SD above the population mean for unmedicated individuals after correction for sex, age, age 2 , and body mass index (Table 1).…”

Pulse Pressure and Coronary Atherosclerosis Progression in Postmenopausal Women

“…20 In small clinical studies, use of angiotensin-converting enzyme inhibitors (␤-blockers), diuretics, and clonidine have been associated with modest reductions in arterial stiffness. [33][34][35] Statin use has also been associated with reduced arterial stiffness independent of reductions in cholesterol in patients with hypercholesterolemia. 36 None of these agents are designed to specifically modify arterial composition.…”

Influence of hypertension on lower urinary tract symptoms in benign prostatic hyperplasia

“…2,5,7 Among non-selective alpha-1 antagonists used for the treatment of BPH, terazosin hydrochloride (terazosin), prazosin hydrochloride, and urapidil have also been employed for the treatment of hypertension. [8][9][10] Our previous study showed that elderly patients with nocturia had a higher blood pressure and higher serum catecholamine levels when compared with healthy elderly controls. 11 Therefore, hypertension itself seems to have an adverse influence on lower urinary tract symptoms (LUTS).…”