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Morning BP reduction: which drug can lower most?
104A
POSTERS: Antihypertensive Drugs
P-192 EFFECT OF EPROSARTAN ON PULSE PRESSURE AND OTHER BLOOD PRESSURE COMPONENTS IN PATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION Alejandro De la Sierra, Anna Mun˜ oz, Emma Arcos, Juan-Salvador Lo´ pez, Jordi Relats. Hypertension Unit. Department of Internal Medicine, Hospital Clinic, Barcelona, Spain; Solvay Pharmaceuticals, Barcelona, Spain; PharmaConsult Services S.A., Barcelona, Spain. Pulse pressure (PP) is recognized as one of the most important cardiovascular risk factor in older subjects and those with isolated systolic hypertension. The aim of the study was to evaluate the effect of the angiotensin receptor blocker eprosartan on pulse pressure in patients with isolated systolic hypertension. Furthermore, we tried to to identify those factors influencing such effect. This is an observational study performed in 895 patients with isolated systolic hypertension (SBP ⱖ140 and DBP ⬍ 90 mmHg), 57% women with a mean age of 70 years. All these patients completed 16 weeks of treatment with eprosartan (87% in monotherapy) in primary care centers. Blood pressure was measured by means of a validated oscillometric device (OMRON 705CP), provided with a printer. Eprosartan significantly (p⬍0.001) reduced PP (23 mmHg) at 16 weeks. The SBP reduction (26,0 mmHg) was also statistically significant (p⬍0.001), whereas DBP remained unchanged (3.1 mmHg). No significant differences were observed in any of these parameters comparing patients who received either eprosartan monotherapy or combined with other antihypertensive agents. The response to eprosartan was influenced by the presence of a family history of early cardiovascular disease, but no by age, gender, body mass index, the presence of diabetes mellitus, hypercholesterolemia smoking habits, left ventricular hypertrophy or previous cardiovascular complications. After correcting PP by the severity of hypertension (PP/mean BP index), eprosartan reduced such index from 76% to 61%, suggesting a 15 reduction in the pulsatile component independently of the static component. Adverse drug reactions appeared in 1% of exposed patients. We conclude that eprosartan is an effective and well tolerated antihypertensive drug able to reduce PP in patients with isolated systolic hypertension. This reduction is partially independent of the severity of high blood pressure. This aspect may be important in terms of safety and target organ protection.
AJH–May 2004 –VOL. 17, NO. 5, PART 2
p⬍0.0001) and PP (79 ⫾ 22 vs 54 ⫾13 mmHg, p ⫽ 0.003) significantly decreased without effect on heart rate (65 ⫾15 vs 67 ⫾13 b.p.m., p ⫽ NS). SVC and BAD increased while TTRW and BAC were not significantly different. After adjustment by MAP, only BAD remain significant. Left ventricular dP/dt max significantly decreased and no effect was observed in LVET, LVCc CO, CI. This study demonstrates that Telmisartan improves LVF and vascular hemodynamic as showed in SVC, mainly improving the vascular properties in small arterial vessels, independently of the reduction in MAP. TTRW, an index of large arterial vessel stiffness, paradoxically have a tendency to decreased implying higher aortic PWV; this could be explained by counter regulatory mechanism or a not acute effect of the drug on large vessel. Left ventricular function improved with the reduction of dP/dt max. Effects of Termisartan on Arterial Stiffness and Left Ventricular Function
endSBP, mmHg endDBP, mmHg SVC, ml/mm Hg BAD, %/mm Hg TTRW, ms BAC, ml/mm Hg dP/dt max, mmHg/s
Baseline
After 4 weeks of treatment
P
166 ⫾ 17 91 ⫾ 8 0.99 ⫾ 0.22 4.5 ⫾ 1.1 138 ⫾ 44 0.054 ⫾ 0.019 1602 ⫾ 327
128 ⫾ 11 74 ⫾ 8 1.37 ⫾ 0.31 6.5 ⫾ 1.4 124 ⫾ 62 0.068 ⫾ 0.022 1185 ⫾ 195
0.0001 0.0003 0.0026 0.0011 0.5 0.1 0.0002
Key Words: AT1 Receptor Blocker, Arterial Stiffness, Left Ventricular Function
P-194 MORNING BP REDUCTION: WHICH DRUG CAN LOWER MOST? Kazuo Eguchi, Kazuomi Kario, Joji Ishikawa, Kazuyuki Shimada. Department of Cardiology, Jichi Medical School, Tochigi-ken, Japan.
Antonio J Delgado, Carlos L Delgado-Leon. Hypertension Research Unit, University of Carabobo, Valencia, Carabobo, Venezuela.
Background: Successful reduction of morning BP may be beneficial for cardiovascular disease. Methods: We performed ambulatory BP monitoring in 347 uncomplicated essential hypertensives (mean age 68.3years) before and 2-3month after the following long-acting antihypertensive medication: CCB (n⫽130), renin-angiotensin-aldosterone (RAA) inhibitor alone (RAA group;n⫽120),or RAA inhibitor⫹diuretic (RAA⫹D group; n⫽97). Non-responder was defined for those with morning SBPⱖ135mmHg at the baseline and without any reduction in morning SBP by medication. Results: Non-responder rate for morning SBP was significantly lower in CCB than in RAA (10.8% vs. 33.3%, P⬍0.001) and in RAA⫹D (10.8% vs. 28.9%, P⫽0.001). There were no differences for morning BP reduction between RAA and RAA⫹D (Figure). Conclusion: The BP lowering effect of RAA inhibitors on morning BP were not as potent as CCBs even when small dose of diuretic was added.
Since the effects of antihypertensive drugs on arterial stiffness (AS) and LV function (LVF) are complex and vary with time, its clinical evaluation is not possible by only measuring blood pressure (BP). The aim of the study was to evaluate Telmisartan on AS and LVF. Twenty five patients were included (19 females, 12 males, age 56 ⫾10 yrs.). After 3 weeks of wash out, Central BP (endSBP, endDBP, MAP), AS and LVF were recorded at basal and 4 weeks after treatment (Telmisartan 40 mg/day). Using a noninvasive transducer (DynaPulse200M) systemic, regional and local AS were assessed by measuring Systemic Vascular Compliance (SVC), Travel Time of the Reflected Wave (TTRW), Brachial Artery Compliance (BAC) and Distensibility (BAD). LVF was assessed by LV ejection time (LVET), dP/dt max, LV Contractility (LVc), Cardiac Output (CO), Cardiac Index (CI), Stroke Volume (SV) and Stroke Volume Index (SVi). Comparison were made using paired Student’s t-test and level of significance of p ⬍0.05. After treatment (see Table), Central eSBP, eDBP, MAP (111 ⫾ 6 vs 90 ⫾ 8 mmHg,
Key Words: Morning Blood Pressure, Renin Angiotensin Aldosterone Inhibitor, Calcium Channel Blocker
Key Words: Eprosartan, Angiotensin Receptor Blockers, Isolated Systolic Hypertension
P-193 ACUTE EFFECT OF AT1 RECEPTOR BLOCKER TELMISARTAN ON ARTERIAL STIFFNESS AND LEFT VENTRICULAR FUNCTION IN HYPERTENSION
POSTERS: Antihypertensive Drugs
P-192 EFFECT OF EPROSARTAN ON PULSE PRESSURE AND OTHER BLOOD PRESSURE COMPONENTS IN PATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION Alejandro De la Sierra, Anna Mun˜ oz, Emma Arcos, Juan-Salvador Lo´ pez, Jordi Relats. Hypertension Unit. Department of Internal Medicine, Hospital Clinic, Barcelona, Spain; Solvay Pharmaceuticals, Barcelona, Spain; PharmaConsult Services S.A., Barcelona, Spain. Pulse pressure (PP) is recognized as one of the most important cardiovascular risk factor in older subjects and those with isolated systolic hypertension. The aim of the study was to evaluate the effect of the angiotensin receptor blocker eprosartan on pulse pressure in patients with isolated systolic hypertension. Furthermore, we tried to to identify those factors influencing such effect. This is an observational study performed in 895 patients with isolated systolic hypertension (SBP ⱖ140 and DBP ⬍ 90 mmHg), 57% women with a mean age of 70 years. All these patients completed 16 weeks of treatment with eprosartan (87% in monotherapy) in primary care centers. Blood pressure was measured by means of a validated oscillometric device (OMRON 705CP), provided with a printer. Eprosartan significantly (p⬍0.001) reduced PP (23 mmHg) at 16 weeks. The SBP reduction (26,0 mmHg) was also statistically significant (p⬍0.001), whereas DBP remained unchanged (3.1 mmHg). No significant differences were observed in any of these parameters comparing patients who received either eprosartan monotherapy or combined with other antihypertensive agents. The response to eprosartan was influenced by the presence of a family history of early cardiovascular disease, but no by age, gender, body mass index, the presence of diabetes mellitus, hypercholesterolemia smoking habits, left ventricular hypertrophy or previous cardiovascular complications. After correcting PP by the severity of hypertension (PP/mean BP index), eprosartan reduced such index from 76% to 61%, suggesting a 15 reduction in the pulsatile component independently of the static component. Adverse drug reactions appeared in 1% of exposed patients. We conclude that eprosartan is an effective and well tolerated antihypertensive drug able to reduce PP in patients with isolated systolic hypertension. This reduction is partially independent of the severity of high blood pressure. This aspect may be important in terms of safety and target organ protection.
AJH–May 2004 –VOL. 17, NO. 5, PART 2
p⬍0.0001) and PP (79 ⫾ 22 vs 54 ⫾13 mmHg, p ⫽ 0.003) significantly decreased without effect on heart rate (65 ⫾15 vs 67 ⫾13 b.p.m., p ⫽ NS). SVC and BAD increased while TTRW and BAC were not significantly different. After adjustment by MAP, only BAD remain significant. Left ventricular dP/dt max significantly decreased and no effect was observed in LVET, LVCc CO, CI. This study demonstrates that Telmisartan improves LVF and vascular hemodynamic as showed in SVC, mainly improving the vascular properties in small arterial vessels, independently of the reduction in MAP. TTRW, an index of large arterial vessel stiffness, paradoxically have a tendency to decreased implying higher aortic PWV; this could be explained by counter regulatory mechanism or a not acute effect of the drug on large vessel. Left ventricular function improved with the reduction of dP/dt max. Effects of Termisartan on Arterial Stiffness and Left Ventricular Function
endSBP, mmHg endDBP, mmHg SVC, ml/mm Hg BAD, %/mm Hg TTRW, ms BAC, ml/mm Hg dP/dt max, mmHg/s
Baseline
After 4 weeks of treatment
P
166 ⫾ 17 91 ⫾ 8 0.99 ⫾ 0.22 4.5 ⫾ 1.1 138 ⫾ 44 0.054 ⫾ 0.019 1602 ⫾ 327
128 ⫾ 11 74 ⫾ 8 1.37 ⫾ 0.31 6.5 ⫾ 1.4 124 ⫾ 62 0.068 ⫾ 0.022 1185 ⫾ 195
0.0001 0.0003 0.0026 0.0011 0.5 0.1 0.0002
Key Words: AT1 Receptor Blocker, Arterial Stiffness, Left Ventricular Function
P-194 MORNING BP REDUCTION: WHICH DRUG CAN LOWER MOST? Kazuo Eguchi, Kazuomi Kario, Joji Ishikawa, Kazuyuki Shimada. Department of Cardiology, Jichi Medical School, Tochigi-ken, Japan.
Antonio J Delgado, Carlos L Delgado-Leon. Hypertension Research Unit, University of Carabobo, Valencia, Carabobo, Venezuela.
Background: Successful reduction of morning BP may be beneficial for cardiovascular disease. Methods: We performed ambulatory BP monitoring in 347 uncomplicated essential hypertensives (mean age 68.3years) before and 2-3month after the following long-acting antihypertensive medication: CCB (n⫽130), renin-angiotensin-aldosterone (RAA) inhibitor alone (RAA group;n⫽120),or RAA inhibitor⫹diuretic (RAA⫹D group; n⫽97). Non-responder was defined for those with morning SBPⱖ135mmHg at the baseline and without any reduction in morning SBP by medication. Results: Non-responder rate for morning SBP was significantly lower in CCB than in RAA (10.8% vs. 33.3%, P⬍0.001) and in RAA⫹D (10.8% vs. 28.9%, P⫽0.001). There were no differences for morning BP reduction between RAA and RAA⫹D (Figure). Conclusion: The BP lowering effect of RAA inhibitors on morning BP were not as potent as CCBs even when small dose of diuretic was added.
Since the effects of antihypertensive drugs on arterial stiffness (AS) and LV function (LVF) are complex and vary with time, its clinical evaluation is not possible by only measuring blood pressure (BP). The aim of the study was to evaluate Telmisartan on AS and LVF. Twenty five patients were included (19 females, 12 males, age 56 ⫾10 yrs.). After 3 weeks of wash out, Central BP (endSBP, endDBP, MAP), AS and LVF were recorded at basal and 4 weeks after treatment (Telmisartan 40 mg/day). Using a noninvasive transducer (DynaPulse200M) systemic, regional and local AS were assessed by measuring Systemic Vascular Compliance (SVC), Travel Time of the Reflected Wave (TTRW), Brachial Artery Compliance (BAC) and Distensibility (BAD). LVF was assessed by LV ejection time (LVET), dP/dt max, LV Contractility (LVc), Cardiac Output (CO), Cardiac Index (CI), Stroke Volume (SV) and Stroke Volume Index (SVi). Comparison were made using paired Student’s t-test and level of significance of p ⬍0.05. After treatment (see Table), Central eSBP, eDBP, MAP (111 ⫾ 6 vs 90 ⫾ 8 mmHg,
Key Words: Morning Blood Pressure, Renin Angiotensin Aldosterone Inhibitor, Calcium Channel Blocker
Key Words: Eprosartan, Angiotensin Receptor Blockers, Isolated Systolic Hypertension
P-193 ACUTE EFFECT OF AT1 RECEPTOR BLOCKER TELMISARTAN ON ARTERIAL STIFFNESS AND LEFT VENTRICULAR FUNCTION IN HYPERTENSION