Central aortic pressure indices and their correlation with brachial pressure in hypertensive subjects on newer angiotensin receptor blockers olmesartan and telmisartan

Background: Efficacy of Fixed-dose combination of olmesartan and amlodipine on central aortic pressure and Aortic pulse wave velocity (PWV), which are independent predictors of adverse cardiovascular events in hypertension is lacking. Aim of this study was to correlate the effects of fixed-dose combination therapy with olmesartan 20mg and amlodipine 5mg on central aortic blood pressure (CBP) indices in mild to moderate hypertensive subjects with controlled office BP. Methods: Twenty seven patients with brachial systolic BP 140 mmHg and/or diastolic BP 90 mmHg on three office readings who received fixed-dose combination therapy with olmesartan 20mg and amlodipine 5mg for atleast 12 weeks were included. CBP was measured with Periscope using standard cuff BP measurements and proprietary software utilizing a validated transfer function to convert the brachial waveform. Statistical analysis was done with SPSS version 10. Results: Average age of the study group was 47 years. Carotid femoral pulse wave velocity was 1210.2 454.5 cm/sec. Average brachial SBP, DBP and pulse pressure (PP) at the end of the study was 138.8 11.5, 75.9 9.6 and 62.1 12.8 mm of Hg. Average aortic SBP, DBP and pulse pressure (PP) at the end of the study was 121.5 13.8, 75.6 6.0 and 45.4 12.3 mm of Hg. Aortic augmentation pressure and aortic augmentation index noted were 13.7 9.1 mm of Hg and 28.1 10.7 respectively. A significant positive correlation was noted between brachial SBP and aortic SBP (r1⁄40.603, p < 0.001), brachial DBP and aortic DBP (r1⁄40.775, p < 0.001), brachial PP and aortic PP (r1⁄40.622, p<0.001). Conclusions: Combination therapy with fixed-dose olmesartan 20mg and amlodipine 5mg were shown to substantially benefit pulsatile hemodynamics (i.e. CBP and indices, AIx and PWV) and have beneficial effects on central aortic BP beyond brachial BP lowering with excellent correlation between the two BP parameters.