Local pulse pressure and regression of arterial wall hypertrophy during long term antihypertensive treatment. CELIMENE study

Background: Local Pulse Pressure (PP) is an independent determinant of caro tid artery wall thickness, stronger than mean BP. The present study was des igned to assess whether a beta-adrenoceptor antagonist or an ACE inhibitor- based treatment was able to reduce carotid artery wall hypertrophy through the reduction in carotid PP rather than by lowering mean BP, and whether th e influence of local PP reduction could also be detected at the site of a m uscular artery, the radial artery. Methods and results: Ninety-eight essential hypertensive patients were rand omised to 9 months of double-blind treatment with either celiprolol or enal april. Arterial parameters were determined with high resolution echotrackin g systems. PP was measured locally with PP applanation tonometry, and indep endently of mean BP. After 9 month's treatment, mean BP, carotid PP and int ima-media thickness (IMT) decreased significantly, with no difference betwe en the tow groups. The reduction in carotid pression pulsee, but not in mea n BP, was a major independent determinant of the reduction in carotid IMT. Radial artery IMT and PP decreased significantly with both treatments. Howe ver, the reduction in radial artery IMT was not related to the changes in r adial artery PP. Conclusion: 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 on IMT redu ction was observed at the site of an elastic artery but not at the site of a muscular artery.