A new approach to assessing antihypertensive therapy: effect of treatment on pulse pressure

Citation
P. Asmar et Y. Lacourciere, A new approach to assessing antihypertensive therapy: effect of treatment on pulse pressure, J HYPERTENS, 18(11), 2000, pp. 1683-1690
Citations number
33
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF HYPERTENSION
ISSN journal
02636352 → ACNP
Volume
18
Issue
11
Year of publication
2000
Pages
1683 - 1690
Database
ISI
SICI code
0263-6352(200011)18:11<1683:ANATAA>2.0.ZU;2-R
Abstract
Background A high pulse pressure is an independent cardiovascular risk fact or. It has therefore been suggested that antihypertensive treatment should not only reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP), but should also decrease pulse pressure (SBP minus DBP). In a previo us analysis, we showed that two angiotensin II type 1 (AT(1))-receptor bloc kers, candesartan cilexetil and losartan, differed in their effects in redu cing SBP and DBP. Objective To compare the efficacy of candesartan cilexetil and losartan acc ording to a new approach - their effect on pulse pressure - and to describe the dose-effect relationship for SBP, DBP and pulse pressure, in a placebo -controlled study. Methods After a 4-week placebo run-in period, 268 patients with mild-to-mod erate hypertension were allocated randomly to groups to receive placebo, ca ndesartan cilexetil (8 mg once daily) or losartan (50 mg once daily), for 4 weeks. The doses were then doubled to 16 and 100 mg, respectively, for the final 4 weeks of the study. Clinic blood pressure was measured 24 and 48 h after each dose of drug or placebo, and ambulatory blood pressure was moni tored from 0 to 36 h after each dose, at baseline and after 4 and 8 weeks o f treatment. Results Candesartan cilexetil decreased ambulatory pulse press ure significantly (P < 0.05) more than did losartan during both daytime and night-time, and over the 24 h period after the previous dose. A different dose-effect relationship on SBP, DBP and pulse pressure was observed. The d uration of action of candesartan cilexetil was greater than that of losarta n. After a missed dose (i.e. approximately 24-36 h after the previous dose) , mean ambulatory pulse pressure values after 4 and 8 weeks of treatment wi th candesartan cilexetil were lower than those observed with losartan (P < 0.005). Clinic pulse pressure measurements were consistent with these ambul atory measurements. Conclusions AT(1) -receptor blockers differ both in their ability to reduce pulse pressure and in their duration of effect, candesartan cilexetil havi ng a greater and more sustained effect than losartan. Different dose-effect relationships on SBP, DBP or pulse pressure were observed. Further prospec tive studies based on pulse pressure are needed to analyse the mechanism of reduction of pulse pressure end to determine its prognostic value. J Hyper tens 18:1683-1690 (C) 2000 Lippincott Williams & Wilkins.