Local pulse pressure and regression of arterial wall hypertrophy during long-term antihypertensive treatment

Background-Local pulse pressure (PP) is an independent determinant of carot id artery wall thickness, stronger than mean blood pressure (BP), The prese nt study was designed to assess whether a beta-adrenoceptor antagonist-base d or an ACE inhibitor-based treatment was able to reduce carotid artery wal l hypertrophy through a reduction in carotid PP rather than by lowering mea n BP and whether the influence of local PP reduction could also be detected at the site of a muscular artery, the radial artery. Methods and Results-Ninety-eight essential hypertensive patients were rando mized to 9 months of double-blind treatment with either celiprolol or enala pril, Arterial parameters were determined with high-resolution echo-trackin g systems. PP was measured locally with applanation tonometry and independe ntly of mean BP, After 9 months of treatment, mean BP, carotid PPI and inti mal-medial thickness (IMT) decreased significantly, with no difference betw een the 2 groups. The reduction in carotid PP but not in mean BP was a majo r independent determinant of the reduction in carotid IMT. Radial artery IM T and PP decreased significantly with both treatments. However, the reducti on in radial artery IMT was not related to the changes in radial artery PP. Conclusions-The regression of carotid artery wall hypertrophy during long-t erm antihypertensive treatment was dependent on the reduction in local PP r ather than on the lowering of mean BP. The effect of PP lowering bn IMT red uction was observed at the site of an elastic artery but not at the site of a muscular artery.