This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cushman, W. C. Articles by Reda, D. J. Search for Related Content PubMed PubMed Citation Articles by Cushman, W. C. Articles by Reda, D. J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ATENOLOL CAPTOPRIL CLONIDINE DILTIAZEM HYDROCHLOROTHIAZIDE PRAZOSIN HYDROCHLORIDE Medline Plus Health Information High Blood Pressure Related Collections Clinical Studies

(Hypertension. 2001;38:953.)
© 2001 American Heart Association, Inc.

Fourth Workshop on Structure and Function of Large Arteries

Pulse Pressure Changes With Six Classes of Antihypertensive Agents in a Randomized, Controlled Trial

William C. Cushman; Barry J. Materson; David W. Williams; Domenic J. Reda; for the Veterans Affairs Cooperative Study Group on Antihypertensive Agents

From the Veterans Affairs Medical Center (W.C.C.), Memphis, Tenn; University of Miami School of Medicine (B.J.M.), Miami, Fla; and Veterans Affairs Cooperative Studies Program Coordinating Center (D.W.W., D.J.R.), Hines, Ill.

Correspondence to William C. Cushman, MD, Chief, Preventive Medicine (111Q), Veterans Affairs Medical Center, 1030 Jefferson Ave, Memphis, TN 38104. E-mail William.Cushman{at}med.va.gov

Abstract

Abstract—— Pulse pressure has been more strongly associated with cardiovascular outcomes, especially myocardial infarction and heart failure, than has systolic, diastolic, or mean arterial pressure in a variety of populations. Little is known, however, of the comparative effects of various classes of antihypertensive agents on pulse pressure. In retrospective analyses of the Veterans Affairs Single-Drug Therapy for Hypertension Study, we compared changes in pulse pressure with 6 classes of antihypertensive agents: 1292 men with diastolic blood pressure of 95 to 109 mm Hg on placebo were randomized to receive hydrochlorothiazide, atenolol, captopril, clonidine, diltiazem, prazosin, or placebo. Drug doses were titrated to achieve a goal diastolic blood pressure of <90 mm Hg during a 4- to 8-week medication titration phase. Pulse pressure change (placebo subtracted) was assessed from baseline to the end of the 3-month titration and 1-year maintenance. Mean baseline systolic, diastolic, and pulse pressures were 152, 99, and 53 mm Hg, respectively. Reductions in pulse pressure during titration were greater (P<0.001) with clonidine (6.7 mm Hg) and hydrochlorothiazide (6.2 mm Hg) than with captopril (2.5 mm Hg), diltiazem (1.6 mm Hg), and atenolol (1.4 mm Hg); reduction with prazosin (3.9 mm Hg) was similar to all but clonidine. After 1 year, pulse pressure was reduced significantly more (P<0.001) with hydrochlorothiazide (8.6 mm Hg) than with captopril and atenolol (4.1 mm Hg with both); clonidine (6.3 mm Hg), diltiazem (5.5 mm Hg), and prazosin (5.0 mm Hg) were intermediate. These data show that classes of antihypertensive agents differ in their ability to reduce pulse pressure. Whether these differences affect rates of cardiovascular events remains to be determined.

Key Words: pulse pressure • antihypertensive agents • drug therapy • human

This article has been cited by other articles:

				M. J. Roman, R. B. Devereux, J. R. Kizer, E. T. Lee, J. M. Galloway, T. Ali, J. G. Umans, and B. V. Howard Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure: The Strong Heart Study Hypertension, July 1, 2007; 50(1): 197 - 203. [Abstract] [Full Text] [PDF]

				S. J. Bielinski, A. I. Lynch, M. B. Miller, A. Weder, R. Cooper, A. Oberman, Y.-D. I. Chen, S. T. Turner, M. Fornage, M. Province, et al. Genome-Wide Linkage Analysis for Loci Affecting Pulse Pressure: The Family Blood Pressure Program Hypertension, December 1, 2005; 46(6): 1286 - 1293. [Abstract] [Full Text] [PDF]

				S. J. Zieman, V. Melenovsky, and D. A. Kass Mechanisms, Pathophysiology, and Therapy of Arterial Stiffness Arterioscler. Thromb. Vasc. Biol., May 1, 2005; 25(5): 932 - 943. [Abstract] [Full Text] [PDF]

				G. V. Nair, D. Waters, W. Rogers, G. J. Kowalchuk, T. D. Stuckey, and D. M. Herrington Pulse Pressure and Coronary Atherosclerosis Progression in Postmenopausal Women Hypertension, January 1, 2005; 45(1): 53 - 57. [Abstract] [Full Text] [PDF]

				S. I. Chaudhry, H. M. Krumholz, and J. M. Foody Systolic Hypertension in Older Persons JAMA, September 1, 2004; 292(9): 1074 - 1080. [Abstract] [Full Text] [PDF]

				M. Ronnback, J. Fagerudd, C. Forsblom, K. Pettersson-Fernholm, A. Reunanen, P.-H. Groop, and on behalf of the Finnish Diabetic Nephropathy Stu Altered Age-Related Blood Pressure Pattern in Type 1 Diabetes Circulation, August 31, 2004; 110(9): 1076 - 1082. [Abstract] [Full Text] [PDF]

				N. J. Camp, P. N. Hopkins, S. J. Hasstedt, H. Coon, A. Malhotra, R. M. Cawthon, and S. C. Hunt Genome-Wide Multipoint Parametric Linkage Analysis of Pulse Pressure in Large, Extended Utah Pedigrees Hypertension, September 1, 2003; 42(3): 322 - 328. [Abstract] [Full Text] [PDF]

				D. Goldsmith, R. MacGinley, A. Smith, and A. Covic How important and how treatable is vascular stiffness as a cardiovascular risk factor in renal failure? Nephrol. Dial. Transplant., June 1, 2002; 17(6): 965 - 969. [Full Text] [PDF]