Hypertension. 2001;38:922-926
doi: 10.1161/hy1001.095774
doi: 10.1161/hy1001.095774
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(Hypertension. 2001;38:922.)
© 2001 American Heart Association, Inc.
Fourth Workshop on Structure and Function of Large Arteries |
Improvement in Blood Pressure, Arterial Stiffness and Wave Reflections With a Very-Low-Dose Perindopril/Indapamide Combination in Hypertensive Patient
A Comparison With Atenolol
From Hôpital Broussais (M.E.S.), Paris, France; Institut Cardiovasculaire (R.G.A.), Paris, France; Hôpital Manhès (G.M.L.), Fleury-Mérogis, France; and St-Vincent Hospital (M.O.R.), Darlinghurst, Australia.
Correspondence to Prof Michel Safar, Médecine Interne 1, Groupe Hospitalier Broussais–George Pompidou, 96, rue Didot, 75674,Paris Cedex 14 France. E-mail michel.safar{at}brs.ap-hop-paris.fr
Abstract
Abstract—— International guidelines recommend that antihypertensive drug therapy should normalize not only diastolic (DBP) but also systolic blood pressure (SBP). Therapeutic trials based on cardiovascular mortality have recently shown that SBP reduction requires normalization of both large artery stiffness and wave reflections. The aim of the present study was to compare the antihypertensive effects of the very-low-dose combination indapamide (0.625 mg) and perindopril (2 mg) (Per/Ind) with the ß-blocking agent atenolol (50 mg) to determine whether Per/Ind decreases SBP and pulse pressure (PP) more than does atenolol and, if so, whether this decrease is predominantly due to reduction of aortic pulse wave velocity (PWV) (automatic measurements) and reduction of wave reflections (pulse wave analysis, applanation tonometry). In a double-blind randomized study, 471 patients with essential hypertension were followed for 12 months. For the same DBP reduction, Per/Ind decreased brachial SBP (-6.02 mm Hg; 95% confidence interval, -8.90 to -3.14) and PP (-5.57; 95% confidence interval, -7.70 to -3.44) significantly more than did atenolol. This difference was significantly more pronounced for the carotid artery than for the brachial artery. Whereas the 2 antihypertensive agents decreased PWV to a similar degree, only Per/Ind significantly attenuated carotid wave reflections, resulting in a selective decrease in SBP and PP. The very-low-dose combination Per/Ind normalizes SBP, PP, and arterial function to a significantly larger extent than does atenolol, a hemodynamic profile that is known to improve survival in hypertensive populations with high cardiovascular risk.
Key Words: antihypertensive therapy • pulse wave velocity • pulse pressure
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