Effect of antihypertensive therapy on pulse pressure

BACKGROUND: Pulse pressure (difference between systolic and diastolic pressure) is an important prognostic factor for cardiovascular mortality and morbidity in elderly hypertensives. However, data regarding the effect of antihypertensive treatment on pulse pressure (PP) are scarce. In the present study, we evaluate the effect of six classes of antihypertensive drugs on PP in an elderly hypertensive cohort. PATIENTS AND METHOD: It was an open, prospective and multicenter study performed by primary care physicians. 857 hypertensive patients (54% women) with a mean age of 68 years were included. Antihypertensive treatment (any antihypertensive drug used in monotherapy) was freely assigned by investigators and then grouped in classes for analysis. Blood pressure was measured by a validated oscillometric device using a standardized protocol. RESULTS: ACE inhibitors were the mostly used class of antihypertensive drugs (27.8%). We found no differences between drug classes in PP reduction. Likewise, no differences were observed regarding the effect on systolic, diastolic, and mean blood pressure. The percentage of adverse reactions was low (6.3%). When effects on PP reduction and adverse reactions were pooled together, angiotensin receptor blockers emerged as the antihypertensive drug class with the best profile. CONCLUSIONS: Antihypertensive drugs do not differ substantially in their ability to reduce PP. Although PP is considered as an important prognostic factor for cardiovascular mortality and morbidity, the present results do not strengthen its usefulness as a distinctive marker of antihypertensive drug classes.