The Effect of Isosorbide Dinitrate Intravenous Injection on the Hemodynamics and Arterial Stiffness of Patients with Isolated Systolic Hypertension

ABSTRACT

BACKGROUND AND OBJECTIVES: In clinical practice, isolated systolic hypertension (ISH) is common for elderly patients and it is correlated with cardiovascular mortality. However, it is difficult to control the systolic blood pressure (BP) with using the currently available antihypertensive drugs without influencing the diastolic BP. The purpose of this study is to evaluate the effect of isosorbide dinitrate on the central BP and arterial stiffness by performing invasive testing. SUBJECTS AND METHODS: Thirty subjects who had ISH and who underwent coronary angiography were enrolled in this study. The invasively measured central blood pressure, pulse pressure and pulse wave velocity were obtained after isosorbide dinitrate was injected intravenously and these values were analyzed in relation to age, gender, the body mass index, diabetes mellitus, dyslipidemia, smoking and the current dosing with antihypertensive drugs. RESULTS: One minute after intravenous injection of isosorbide dinitrate, the central systolic BP was significantly decreased compare to the baseline value (142.23+/-12.32 mmHg vs 164.97+/-14.43 mmHg, respectively, p<0.001), and this change was sustained for 5 minutes (141.05+/-14.84 mmHg vs 164.97+/-14.43 mmHg, respectively, p<0.001). The mean values, during the 5 minute period, of the pulse pressure (65.99+/-13.63 mmHg vs 87.30+/-13.71 mmHg, respectively, p<0.001) and the pulse wave velocity (11.22+/-3.20 m/sec vs 12.91+/-4.11 m/sec, respectively, p<0.001) also revealed significant changes. Yet there was no significant decrease of the diastolic BP. Analysis of subgroups that were classified by gender, age, BMI, diabetes mellitus, dyslipidemia, smoking, the degree of the systolic BP and PWV, and taking antihypertensive drugs showed a similar pattern. CONCLUSION: Isosorbide dinitrate was very effective for selective control of the systolic BP in ISH patients. It is also expected to prevent cardiovascular complications by improving arterial stiffness.