COMPARED EFFECTS OF ANGIOTENSION CONVERTI NG-ENZYME INHIBITORS AND CALCIUM-ANTAGONISTS ON PULSE PRESSURE AND BLOOD-PRESSURE VARIABILITY ASSESSED BY AMBULATORY MONITORING IN MILD-TO-MODERATE HYPERTENSIVE PATIENTS

Objective : this retrospective study was aimed: at comparing the effec ts of angiotensin converting enzyme inhibitors (ACEI) and those of cal cium antagonists (CA) on the pulse pressure of mild to moderate hypert ensive patients ; at assessing whether these effects were associated w ith some modifications of blood pressure variability or not. Methods : the ambulatory blood pressure (ABP) recordings of 236 patients who pr eviously entered clinical trials with a mean run-in placebo period of 2 weeks and a mean active treatment phase of 6 weeks (ACEI, n = 115 ; CA, n = 121) were reviewed. Baseline ABP has been analysed both as a c ontinuous variable and as a categorical one (high when > 139/87 mmHg, low otherwise). Pulse pressure was calculated by the difference systol ic ABP-diastolic ABP, whereas BP variability was estimated by the stan dard deviation and the variation coefficient of each recording. The re sults are given as percentage (mean +/- standard deviation). In the pa tients with high baseline systolic ABP, ACEI and CA did not significan tly differ regarding their effects on pulse pressure (-11.1 +/- 17.2 v s - 6.3 +/- 14.0, NS). By contrast, in the other patients, pulse press ure was lowered to a significantly greater degree by ACEI than by CA ( -5.5 +/- 18.7 vs + 1.8 +/- 18.8, p = 0.04). These differences were not related to baseline diastolic ABP. No difference at all was found wit h regard to BP variability which was altered by none of the drugs. In conclusion, pulse pressure, a reliable indicator of arterial complianc e, seemed to be more decreased by ACEI than by CA, the difference bein g significant only in patients with apparent hypertension.