Effects of antihypertensive drugs on central blood pressure in humans: a preliminary observation.
BACKGROUND
Central blood pressure (BP) is considered a better predictor of cardiovascular events than brachial BP. Modifications of central, beyond brachial BP, can be assessed by pressure amplification, a potential new cardiovascular risk factor. Comparison between drugs' effect on central hemodynamics has been poorly studied. Our aim was to assess the hemodynamic effect of a 12-week treatment with amlodipine 5mg, or candesartan 8mg, or indapamide sustained-release 1.5mg, in comparison with placebo.


METHODS
We analyzed 145 out-patients with essential hypertension in primary prevention enrolled in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) study, a multicenter, randomized, double-blinded, placebo-controlled trial. Arterial stiffness, central BP, pressure amplification, and wave reflection were measured by applanation tonometry.


RESULTS
Baseline characteristics of patients were homogeneous between groups. After treatment, we found that active drugs produced similar reduction of both central and peripheral BPs, with no significant interdrug differences (all P < 0.05; excluded peripheral pulse pressure, compared with placebo). Second, amlodipine (1.9% ± 15.3%), candesartan (3.0% ± 14.6%) and indapamide (4.1% ± 14.4%) all increased pulse pressure amplification, but only indapamide was statistically different from placebo (P = 0.02). Finally, no significant changes were observed on pulse wave velocity, heart rate, and augmentation index.


CONCLUSIONS
The 3 antihypertensive drugs similarly reduced peripheral and central BP, as compared with placebo, but a significant increase in pulse pressure amplification was obtained only with indapamide, independently of arterial stiffness modifications.


REGISTRATION NUMBER
3283161 by BIOPHARMA.
['Agnoletti|Davide|D|', 'Zhang|Yi|Y|', 'Borghi|Claudio|C|', 'Blacher|Jacques|J|', 'Safar|Michel E|ME|']
D000368:Aged D017311:Amlodipine D000959:Antihypertensive Agents D001011:Aorta D062186:Arterial Pressure D001562:Benzimidazoles D001713:Biphenyl Compounds D001794:Blood Pressure D001795:Blood Pressure Determination D001916:Brachial Artery D004311:Double-Blind Method D005260:Female D006801:Humans D006973:Hypertension D007190:Indapamide D008297:Male D008365:Manometry D008875:Middle Aged D063177:Pulse Wave Analysis D013777:Tetrazoles D016896:Treatment Outcome D059289:Vascular Stiffness
central blood pressure blood pressure pressure amplification hypertension arterial stiffness antihypertensive agents wave reflection.