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(Hypertension. 2005;45:352.)
© 2005 American Heart Association, Inc.

Editorial Commentaries

Nitrates as Adjunct Hypertensive Treatment

A Possible Answer to Resistant Systolic Hypertension

From The University of Texas Southwestern Medical Center, Dallas.

Correspondence to Shawna D. Nesbitt MD, MS, Assistant Professor of Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8899. E-mail shawna.nesbitt@utsouthwestern.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Systolic hypertension occurs most commonly in the elderly and it significantly increases cardiovascular and cerebrovascular risk. Furthermore, although once thought inadvisable, treatment with various drug choices has been clearly shown to be beneficial.^1,2,3 Despite concerted efforts to reach blood pressure goal in these studies, none of them has achieved blood pressures of <140/90 mm Hg. Furthermore, based on National Health and Nutrition Examination Survey, the elderly have the poorest rates of achieving blood pressure control.⁴ This raises the query of whether the lack of success is a matter of compliance versus a physiological aberration, which conventional therapy does not completely address. The article "Long-Term Effectiveness of Extended-Release Nitrate for the Treatment of Systolic Hypertension" by Stokes et al in this issue addresses the utility of an old agent, "nitrates," to improve blood pressure control in resistant systolic hypertension.⁵

An interesting facet of this treatment approach is the synchronization of the mechanism of action of the drug with an individualized underlying pathophysiology of disease. This is a concept that has been discussed in hypertension but is quite difficult to implement without easily accessible methods to assess pathophysiology. In the case of systolic hypertension, newer noninvasive techniques of measuring compliance may represent a helpful tool in defining the most specific antihypertensive regimen. The current study makes use of the Sphygmocor device to assess arterial compliance and distensibility. Although this device and others like it have some inherent inaccuracies because of the assumptions made in the calculations, there are studies to suggest that . . . [Full Text of this Article]