Therapeutic studies and arterial stiffness in hypertension: recommendations of the European Society of Hypertension

Background Increased pulse pressure and arterial stiffness are identified a s predictors of cardiovascular risk in older hypertensive populations, part icularly that of myocardial infarction. Because increased pulse pressure in volves an increase in systolic (SBP) and a decrease in diastolic blood pres sure (DBP), and because the former promotes cardiac hypertrophy and the lat ter alters coronary perfusion, a drug regimen reducing pulse pressure and d ecreasing arterial stiffness might further reduce cardiovascular risk Under conventional treatment, normalization of DBP (less than or equal to 90 mmH g) is not consistently associated with normalization of SBP (less than or e qual to 140 mmHg). Therapeutic designs In individuals older than 50 years, the goal of antihyp ertensive treatment should be, not only to decrease mean blood pressure (to less than 100 mmHg), but also to decrease pulse pressure (to less than 50 mmHg). Using appropriate pharmacological tools, trials should test whether an active decrease in arterial stiffness might produce an attenuation of th e age-related increase in SBP and decrease in DBP, thus delaying the age-re lated increase in pulse pressure and decreasing further cardiovascular risk . This procedure requires concomitant non-invasive evaluations of aortic st iffness. Conclusion The studies that are required in hypertension should use two dif ferent approaches: novel titrations of conventional drugs to achieve a decr ease in either SBP or pulse pressure, and development of new drugs acting s electively on the large artery wall, to facilitate the conduct of subsequen t controlled trials. J Hypertens 18:1527-1535 (C) 2000 Lippincott Williams & Wilkins.