The effect of treatment with eprosartan on pulse pressure: factors predicting response.

BACKGROUND: Pulse pressure is an important cardiovascular risk factor, particularly in the elderly and in patients with isolated systolic hypertension. The differential impact of antihypertensive agents on pulse pressure is not known. OBJECTIVE: To assess the antihypertensive effect of treatment with the angiotensin II receptor blocker eprosartan on pulse pressure, and the factors influencing this effect. METHODS: The present study was an observational study of 4067 patients (55% women, mean age 67 years) with essential hypertension, newly diagnosed or unresponsive to current treatment, in which 3133 patients received 12 weeks of treatment with eprosartan 600 mg/day (87% monotherapy) in primary care centres. Blood pressure was measured using a validated oscillometric device (Omron 705CP, Omron Healthcare Inc, USA). RESULTS: Eprosartan significantly reduced pulse pressure at 12 weeks (13.5 mmHg, P<0.001). The reductions in systolic, diastolic and mean blood pressures were also statistically significant (26.0 mmHg, 12.6 mmHg and 17.1 mmHg, respectively). After correcting the pulse pressure for hypertension severity (pulse pressure/mean blood pressure ratio), this index was reduced from 62% to 58% with eprosartan, suggesting a 4% reduction in the pulsatile component. This reduction was more pronounced in patients over 60 years of age, those with a higher index at baseline and those with hypertensive cardiovascular complications. Adverse drug reactions occurred in 1.5% of patients. CONCLUSION: Eprosartan is an effective, well tolerated antihypertensive drug that reduces pulse pressure. This reduction is partially independent of the severity of high blood pressure, which may be important for both safety and target organ protection.

Effect of eprosartan on pulse pressure and blood pressure components in patients with isolated systolic hypertension.

BACKGROUND: Systolic blood pressure (SBP) and pulse pressure (PP) are accurate predictors of cardiovascular events in the elderly population. In these patients, isolated systolic hypertension (ISH) is an important risk factor for cardiovascular morbidity and mortality. STUDY DESIGN: A multicentre, observational, prospective study, evaluated the effects of 16 weeks of eprosartan treatment on PP and other blood pressure (BP) parameters. Data from a subgroup of patients from this study, who had ISH, are presented here. RESULTS: Eprosartan monotherapy reduced SBP, PP and mean blood pressure (MBP) over the duration of treatment, whereas diastolic blood pressure (DBP) remained unchanged. There was no difference in the reductions of these parameters between eprosartan monotherapy and combination therapy. In addition, a high proportion of patients responded to eprosartan therapy. The response to eprosartan therapy was significantly influenced by family history of early cardiovascular disease, but not by gender, body mass index (BMI), raised low-density lipoprotein (LDL)-cholesterol, smoking, left ventricular hypertrophy, or previous history of cardiovascular disease. Patients aged > or =70 years had a decreased reduction in DBP and MBP components. Eprosartan therapy was well tolerated, with only 1% of patients reporting an adverse event. CONCLUSIONS: Eprosartan is an effective and well-tolerated antihypertensive therapy for elderly patients with ISH.

[Effect of antihypertensive therapy on pulse pressure]. / Efecto del tratamiento antihipertensivo sobre la presión de pulso.

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.