Comparison of the Effects of Antihypertensive Agents on Central Blood Pressure and Arterial Stiffness in Isolated Systolic Hypertension Efficacy of various antihypertensive agents as evaluated by indices of vascular stiffness in elderly hypertensive patients. Reduction in arterial stiffness with angiotensin II antagonist is comparable with and additive to ACE inhibition. Markers of Inflammation, Endothelial Activation, and Arterial Stiffness in Hypertensive Heart Disease and the Effects of Treatment: Results From the SILVHIA Study Aggressive antihypertensive strategies based on hydrochlorothiazide, candesartan or lisinopril decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension To compare the effect of Telmisartan with Metoprolol on arterial stiffness in hypertension: prospective randomized parallel group trial. Supplementation with vitamins C and E improves arterial stiffness and endothelial function in essential hypertensive patients. A randomized, double-blind study of valsartan versus metoprolol on arterial distensibility and endothelial function in essential hypertension. Improving hypertension care in a large group-model MCO. Rational Prescribing in Primary Care (RaPP): A Cluster Randomized Trial of a Tailored Intervention A CONTROLLED STUDY OF THE EFFECTS OF AEROBIC EXERCISE ON ANTIHYPERTENSIVE DRUG REQUIREMENTS OF ESSENTIAL HYPERTENSIVE PATIENTS IN THE GENERAL PRACTICE SETTING Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): Practical Implications Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension Improved Arterial Compliance by a Novel Advanced Glycation End-Product Crosslink Breaker Usefulness of Serum Carboxy-Terminal Propeptide of Procollagen Type I in Assessment of the Cardioreparative Ability of Antihypertensive Treatment in Hypertensive Patients [Efficacy of monotherapy with 15 antihypertensive agents in treating essential hypertension assessed by 24-hour ambulatory blood pressure monitoring]. Double-blind, placebo-controlled crossover comparison of five classes of antihypertensive drugs
Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening . Although various drug therapies are used to lower peripheral blood pressure ( BP ) in patients with isolated systolic hypertension , the effects of the 4 major classes of antihypertensive agents on central BP , pulse pressure ( PP ) amplification , and arterial stiffness in this condition are not clear . Fifty-nine patients over the age of 60 years with untreated isolated systolic hypertension ( systolic BP ≥140 mm Hg and diastolic BP ≤90 mm Hg ) were r and omly assigned to receive 1 of the following 4 antihypertensive agents : perindopril , atenolol , lercanidipine , or bendrofluazide  . BP was measured using a mercury sphygmomanometer , and augmentation index and carotid-femoral ( aortic ) pulse wave velocity were measured at baseline , after 2 weeks of placebo therapy , and at the end of 10 weeks of active therapy . Peripheral systolic BP and peripheral PP were reduced similarly after treatment with all 4 classes of drug . However , central PP was only reduced significantly by perindopril , lercanidipine , and bendrofluazide , whereas atenolol had no effect . Lercanidipine reduced the augmentation index , whereas atenolol increased it . Aortic pulse wave velocity was not changed by any of the drugs . In summary , despite similar reductions in peripheral systolic and PPs with the 4 classes of drug , changes in central pressure and augmentation index varied . Because central PP and increased wave reflections are considered important risk factors in patients with isolated systolic hypertension , the choice of therapy may be influenced by these findings in the future When observed in elderly hypertensive patients , increased pulse pressure ( PP ) and arterial stiffness are known to be independent risk factors for cardiovascular diseases . Increased systolic blood pressure ( SBP ) leads to left ventricular hypertrophy , while decreased diastolic blood pressure ( DBP ) results in decreased coronary circulation . It is known that increased arterial stiffness is the major cause of increased PP . Thus basic morbid states of cardiac failure or ischemic heart diseases are more likely to develop in elderly hypertensive patients with increased PP and arterial stiffness , and there is need of antihypertensive drugs that decrease these effects in elderly hypertensives . In this study , we compared the effects of an angiotensin-receptor blocker ( ARB : valsartan ) , an angiotensin-converting enzyme inhibitor ( ACE-I : temocapril ) , and long-acting Ca antagonists ( L- and N-type Ca channel blocker : cilnidipine ; and L-type Ca channel blocker : nifedipine CR ) on PP and arterial stiffness measured by pulse wave velocity in elderly hypertensive patients for 3 months . The ARB yielded the largest reductions in PP and brachial-ankle pulse wave velocity ( baPWV ) , followed by the ACE-I and L- and N-type Ca channel blocker , while the L-type Ca channel blocker yielded no improvement . The effects on arterial stiffness and PP thus varied among the drug characteristics . Although ARB achieved the largest reduction in baPWV , this decrease was not associated with any reductions in PP , SBP , DBP , or mean blood pressure , as were the baPWV-decreases achieved by the other drugs , suggesting that ARB may further reduce the risk of arteriosclerosis in elderly hypertensive patients by decreasing arterial stiffness in addition to its antihypertensive effect We measured the effects of angiotensin II blockade on arterial stiffness , augmentation index ( AI% ) , pulse wave velocity ( PWV ) , and blood pressure ( BP ) in 12 hypertensive patients ( mean 49 + /- 11 years ) in a 4-week , r and omized , cross-over study comparing valsartan 160 mg/day with captopril 100 mg/day , with a 2-week washout period . Subsequently both therapies were combined . Reductions in PWV and AI% remained significant when corrected for BP . Combined therapy reduced PWV and AI% ( P < .05 ) more than monotherapy , even when corrected for BP . The study shows that angiotensin receptor antagonists reduce arterial stiffness in hypertension comparable with and possibly additive to angiotensin converting enzyme inhibition Abstract : We assessed the contribution of blood pressure ( BP ) , inflammation , and endothelial activation to the development of structural vascular and cardiac changes in hypertension . Furthermore , the effects of antihypertensive therapy were studied . We studied 114 patients with hypertension and left ventricular hypertrophy and 38 matched hypertensive subjects without cardiac hypertrophy and 38 normotensive subjects . The group with hypertension and cardiac hypertrophy were r and omized to treatment with an angiotensin receptor blocker ( irbesartan ) or a beta-adrenergic receptor blocker ( atenolol ) for 48 weeks . Markers of inflammation ( high-sensitive C-reactive protein , interleukin-6 , leukocyte counts ) , vascular function ( ambulatory aortic stiffness index , arterial compliance , and pulse pressure ) , and endothelial activation ( E-selectin , intracellular adhesion molecule-1 , vascular adhesion molecule-1 ) were assessed . Markers of inflammation and arterial stiffness were lowest in the normotensive group and highest in patients with hypertensive heart disease ; endothelial markers were similar between groups . Inflammation was independently related to BP . Markers of arterial stiffness were independently related to BP and to a lesser extent to left ventricular mass . Antihypertensive treatment improved arterial compliance ; inflammatory and endothelial markers remained unchanged . In conclusion , markers of inflammation and arterial stiffness are independently related to BP . Antihypertensive therapy seems to improve arterial stiffness , but effects on markers of inflammation and endothelial activation are small We investigated the effects of aggressive antihypertensive therapy based on hydrochlorothiazide , c and esartan or lisinopril on left ventricular mass ( LVM ) index and arterial stiffness in hypertensive type II diabetic individuals . Seventy hypertensive type II diabetic individuals were treated with three antihypertensive strategies in a r and omized , double-blind , double-dummy design . Blood pressure was titrated to levels below 130/85 mm Hg or a decrease in systolic pressure of 10 % with a diastolic pressure below 85 mm Hg . After titration , patients were treated for 12 months . Mean blood pressures were 157/93 , 151/94 and 149/93 mm Hg at baseline in the hydrochlorothiazide ( n=24 ) , c and esartan ( n=24 ) and lisinopril ( n=22 ) groups , and 135/80 , 135/82 and 131/80 mm Hg after titration . About 70 % reached target blood pressures , with the median use of three antihypertensive drugs . Left ventricular mass index and all estimates of arterial stiffness showed significant improvement after 12 months : that is , LVM index ( −11 g/m2 ; −8 % ) ; carotid distensibility coefficient ( DC ; + 2.8 × 10−3 kPa−1 ; + 27 % ) , compliance coefficient ( CC ; + 0.13 mm2/kPa ; + 21 % ) and elastic modulus ( −0.19 kPa ; −16 % ) ; femoral DC ( + 1.6 × 10−3 kPa−1 ; + 50 % ) and CC ( + 0.08 mm2/kPa ; + 26 % ) ; brachial DC ( + 2.1 × 10−3 kPa−1 ; + 39 % ) and CC ( + 0.03 mm2/kPa ; + 27 % ) and total systemic arterial compliance ( + 0.29 ml/mm Hg ; + 16 % ) . No differences in outcome variables between treatment groups were observed . Aggressive antihypertensive treatment , although difficult to achieve , result ed in substantial reductions of LVM index and arterial stiffness in relatively uncomplicated hypertensive type II diabetic individuals . Strategies based on renin – angiotensin system inhibitors were not clearly superior to conventional ( i.e. diuretic-based ) strategies BACKGROUND Hypertension is often complicated by increased arterial stiffness and is an independent predictor of adverse cardiovascular ( CV ) outcome . Beta blockers and angiotensin receptor blockers ( ARBs ) are commonly used antihypertensive agents . The effect of beta blockers and ARBs on arterial stiffness has not been compared adequately . The aim of the present study is to compare the effect of telmisartan with metoprolol on arterial stiffness in hypertensive patients in prospect i ve open label r and omized parallel group intervention study . METHODS 100 patients of hypertension , not on any antihypertensive agents , were enrolled after obtaining informed consent . Baseline recording of data related to demographics , CV risk factors , anthropometry and BP were made . Arterial stiffness was measured noninvasively by recording pulse wave velocity ( PWV ) using periscope ( Genesis medical system ) . Left ventricular ( LV ) mass was measured using 2D guided M-mode echocardiography . Blood sugar , renal function , lipids and uric acid estimations were done in fasting state . Patients were r and omized to receive metoprolol and telmisartan using stratified r and omization technique . Dose of the study drugs were titrated to achieve target BP of < 140/90 mmHg . Data related to PWV , BP , anthropometry and blood biochemistry was repeated after 6 months of treatment with study drugs . RESULTS Telmisartan result ed in significantly greater reduction in arterial stiffness index ( ASI ) in left and right lower limb arterial bed ( 39.9 ± 11.7 vs. 46.8 ± 17.0 m/s , p < 0.02 ) and ( 36.4 ± 9.6 vs. 44.86 ± 15.1 m/s , p < 0.002 ) respectively and systolic blood pressure ( SBP ) ( -4.9 mmHg with 95 % C.I. of -8.0 - 1.7 mmHg , p < 0.003 ) compared to metoprolol . Reduction in diastolic blood pressure ( DBP ) in telmisartan and metoprolol groups was not different statistically ( -1.0 mmHg with 95 % C.I. of -3.3 - 1.2 mmHg , p < 0.3 ) . The change in LV mass was not significantly different between the study groups ( 135.5 ± 37.6 vs. 143.2 ± 41.5 , p < 0.3 ) BACKGROUND Essential hypertension is characterized by endothelial dysfunction , arterial stiffness , and increased oxidative stress . We evaluated the effect of short-term combined treatment with the antioxidants vitamins C and E on endothelial function , arterial stiffness , and oxidative stress in untreated essential hypertensive patients . METHODS A r and omized , double-blind , placebo-controlled , crossover study design was used to assign 30 male essential hypertensive patients to either vitamin C ( 1 g ) and vitamin E ( 400 IU ) or placebo for 8 weeks . Endothelium-dependent response was assessed as flow-mediated dilation ( FMD ) of the brachial artery . Arterial stiffness was assessed as central pulse wave velocity ( PWV ) and augmentation index ( AIx ) . Plasma markers of oxidative stress and antioxidant status were measured . RESULTS After vitamin supplementation , FMD was significantly improved . Central PWV was significantly reduced , while AIx tended to decrease . Plasma vitamin levels and antioxidant capacity increased significantly . Levels of oxidative stress decreased . Changes in central PWV were related to changes in levels of oxidative stress . CONCLUSIONS Combined treatment with vitamins C and E has beneficial effects on endothelium-dependent vasodilation and arterial stiffness in untreated , essential hypertensive patients . This effect is associated with changes in plasma markers of oxidative stress BACKGROUND Antihypertensive drugs may have differential , pressure-independent effects on hypertension-associated alterations of arterial function . We compared the effects of a 12-week therapy with the AT(1)-receptor antagonist valsartan ( Val ) versus the beta-blocker metoprolol ( Met ) on arterial stiffness and endothelial function in mildly hypertensive patients at rest and during generalized sympathetic stimulation . METHODS Sixty-eight patients ( 37 male , 31 female , 46 + /- 6 years ) were r and omized to Val ( 80 - 160 mg/d ) or Met ( 50 - 100 mg/d ) . Effects of therapy on endothelial function , brachial and carotid artery distensibility coefficients , pulse wave velocity , carotid intima-media thickness and elastic modulus were assessed at rest and during the cold pressor test . RESULTS Fifty-two patients were available for per protocol analysis . Blood pressure was comparably reduced in both treatment groups . Effects on endothelial function and large artery elastic wall properties did not differ significantly between the two antihypertensive treatment regimens . Trends did not differ significantly between groups for any parameter including carotid intima-media thickness and elastic modulus . CONCLUSION Short-term treatment with Val and Met had similar effects on large artery functional vessel wall properties in a population of mildly hypertensive patients The effectiveness of a quality improvement program for hypertension management practice s and patient health outcomes in a group-model managed care organization was evaluated . Health-system pharmacists analyzed medical and pharmacy cl aims data to identify hypertensive patients . Chart review was conducted on a r and om sample of these patients to vali date a hypertension diagnosis and to obtain blood pressure ( BP ) control rates and prevalence of cardiovascular risk factors and comorbid conditions . The interventions consisted of educating health care providers and recommending appropriate pharmacotherapy for compelling indications . Patient outcomes were compared with baseline hypertension data . After interventions were implemented , medical and pharmacy cl aims identified 30,721 hypertensive patients and chart review s were performed on a r and om sample of 417 patients . Pharmacy cl aims revealed a total of 193,311 antihypertensive prescriptions . Approximately 47 % of all hypertensive patients were managed with monotherapy , while 24 % received dual therapy , and 11 % were taking three or more antihypertensive medications per day . Of the patients on monotherapy , 93 % received an angiotensin-converting-enzyme inhibitor ( 27.3 % ) , diuretic ( 26.6 % ) , beta-blocker ( 23.4 % ) , or calcium channel blocker ( 15.4 % ) . The overall level of BP control significantly improved from 37.2 % at baseline to 49.2 % at follow-up ( p = 0.0007 ) . BP control in the follow-up evaluation was 22.2 % in diabetic patients . For treatment of patients with comorbid disease states , provider practice patterns were evaluated at baseline and follow-up . Improving the quality of hypertension management increased BP control from 37.2 % to 49.2 % . Continued efforts to improve hypertension management , particularly in patients with concomitant diabetes and in elderly patients with isolated systolic hypertension , are needed Background A gap exists between evidence and practice regarding the management of cardiovascular risk factors . This gap could be narrowed if systematic ally developed clinical practice guidelines were effectively implemented in clinical practice . We evaluated the effects of a tailored intervention to support the implementation of systematic ally developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease . Methods and Findings We conducted a cluster-r and omized trial comparing a tailored intervention to passive dissemination of guidelines in 146 general practice s in two geographical areas in Norway . Each practice was r and omized to either the tailored intervention ( 70 practice s ; 257 physicians ) or control group ( 69 practice s ; 244 physicians ) . Patients started on medication for hypertension or hypercholesterolemia during the study period and all patients already on treatment that consulted their physician during the trial were included . A multifaceted intervention was tailored to address identified barriers to change . Key components were an educational outreach visit with audit and feedback , and computerized reminders linked to the medical record system . Pharmacists conducted the visits . Outcomes were measured for all eligible patients seen in the participating practice s during 1 y before and after the intervention . The main outcomes were the proportions of ( 1 ) first-time prescriptions for hypertension where thiazides were prescribed , ( 2 ) patients assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs , and ( 3 ) patients treated for hypertension or hypercholesterolemia for 3 mo or more who had achieved recommended treatment goals . The intervention led to an increase in adherence to guideline recommendations on choice of antihypertensive drug . Thiazides were prescribed to 17 % of patients in the intervention group versus 11 % in the control group ( relative risk 1.94 ; 95 % confidence interval 1.49–2.49 , adjusted for baseline differences and clustering effect ) . Little or no differences were found for risk assessment prior to prescribing and for achievement of treatment goals . Conclusions Our tailored intervention had a significant impact on prescribing of antihypertensive drugs , but was ineffective in improving the quality of other aspects of managing hypertension and hypercholesterolemia in primary care 1 . To investigate the effect of an exercise training programme on antihypertensive drug requirements , 19 sedentary subjects ( 14 men and five women ) with mild essential hypertension ( systolic blood pressure greater than 140 mmHg but less than 180 mmHg ) , aged 29–55 years , were r and omly assigned to 16 weeks of moderate intensity exercise or light intensity exercise ( control ) , and titrated on antihypertensive drug therapy ( captopril and hydrochlorothiazide ) until  resting systolic blood pressure  ( sitting ) of less than 140 mmHg was achieved The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) , sponsored by the National Heart , Lung , and Blood Institute ( NHLBI ) , is the largest outcome trial of antihypertensive treatment ever carried out and the only large blood pressure ( BP ) trial to be carried out in a US population in the past decade.1 The rationale for ALLHAT , which was design ed in the early 1990s , was the urgent need to determine which of the several classes of antihypertensive drugs that had been developed and released for clinical use was most effective in preventing coronary heart disease ( CHD ) , defined as fatal CHD and nonfatal myocardial infa rct ion.2 The only r and omized trials that had previously compared representatives of the antihypertensive drug classes , the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents3 and the Treatment of Mild Hypertension Study (TOMHS),4 showed BP reductions with all classes but were not powered to evaluate CHD outcomes . Further , prior outcome trials had shown that the reduction in CHD event rates with antihypertensive treatment was less than expected based on epidemiologic data .5 Adverse effects of study drugs , particularly diuretics , including hypokalemia , hypomagnesemia , hyperuricemia , hyperlipidemia , insulin resistance , and ventricular ectopic activity , had been adduced to account for the disappointing outcomes of earlier trials by off setting the beneficial effects of BP reduction.6,7 To further complicate the picture , benefits beyond BP reduction had been attributed to some antihypertensive drug classes , ie , improved survival and reduced morbidity in persons with heart failure or left ventricular dysfunction treated with angiotensin-converting enzyme ( ACE ) inhibitors8–10 and improved insulin sensitivity and lipid profiles with α-blocker treatment.11 In contrast , another antihypertensive drug class , the dihydropyridine calcium channel blockers ( CCBs ) , had been associated with unfavorable outcomes in patients with acute myocardial infa rct ion or unstable angina.12 There were no data Background The goal of the present study was to assess the effect of antihypertensive therapy on clinic ( CBP ) and ambulatory ( ABP ) blood pressures , on ECG voltages , and on the incidence of stroke and cardiovascular events in older patients with sustained and nonsustained systolic hypertension . Methods and Results Patients who were ≥60 years old , with systolic CBP of 160 to 219 mm Hg and diastolic CBP of < 95 mm Hg , were r and omized into the double-blind placebo-controlled Systolic Hypertension in Europe ( Syst-Eur ) Trial . Treatment consisted of nitrendipine , with the possible addition of enalapril , hydrochlorothiazide , or both .  Patients enrolled in the Ambulatory Blood Pressure Monitoring Side Project were classified according to daytime systolic ABP into 1 of 3 subgroups : nonsustained hypertension ( < 140 mm Hg ) , mild sustained hypertension ( 140 to 159 mm Hg ) , and moderate sustained hypertension ( ≥160 mm Hg ) . At baseline , patients with nonsustained hypertension had smaller ECG voltages ( P < 0.001 ) and , during follow-up , a lower incidence of stroke ( P < 0.05 ) and of cardiovascular complications ( P = 0.01 ) than other groups . Active treatment reduced ABP and CBP in patients with sustained hypertension but only CBP in patients with nonsustained hypertension ( P < 0.001 ) . The influence of active treatment on ECG voltages ( P < 0.05 ) and on the incidence of stroke ( P < 0.05 ) and cardiovascular events ( P = 0.06 ) was more favorable than that of placebo only in patients with moderate sustained hypertension . Conclusions Patients with sustained hypertension had higher ECG voltages and rates of cardiovascular complications than did patients with nonsustained hypertension . The favorable effects of active treatment on these outcomes were only statistically significant in patients with moderate sustained hypertension Background —Arterial stiffening with increased pulse pressure is a leading risk factor for cardiovascular disease in the elderly . We tested whether ALT-711 , a novel nonenzymatic breaker of advanced glycation end-product crosslinks , selectively improves arterial compliance and lowers pulse pressure in older individuals with vascular stiffening . Methods and Results —Nine US centers recruited and r and omly assigned subjects with resting arterial pulse pressures > 60 mm Hg and systolic pressures > 140 mm Hg to once-daily ALT-711 ( 210 mg ; n=62 ) or placebo ( n=31 ) for 56 days .  Preexisting antihypertensive treatment ( 90 % of subjects ) was continued during the study . Morning upright blood pressure , stroke volume , cardiac output , systemic vascular resistance , total arterial compliance , carotid-femoral pulse wave velocity , and drug tolerability were assessed . ALT-711 netted a greater decline in pulse pressures than placebo ( −5.3 versus −0.6 mm Hg at day 56;P = 0.034 for treatment effect by repeated- measures ANOVA ) . Systolic pressure declined in both groups , but diastolic pressure fell less with ALT-711 ( P = 0.056 ) . Mean pressure declined similarly in both groups ( −4 mm Hg;P < 0.01 for each group , P = 0.34 for treatment effect ) . Total arterial compliance rose 15 % in ALT-711–treated subjects versus no change with placebo ( P = 0.015 versus ALT-711 ) , an effect that did not depend on reduced mean pressure . Pulse wave velocity declined 8 % with ALT-711 ( P < 0.05 at day 56 , P = 0.08 for treatment effect ) . Systemic arterial resistance , cardiac output , and heart rate did not significantly change in either group . Conclusions —ALT-711 improves total arterial compliance in aged humans with vascular stiffening , and it may provide a novel therapeutic approach for this abnormality , which occurs with aging , diabetes , and isolated systolic hypertension Background —We investigated whether serum concentration of carboxy-terminal propeptide of procollagen type I ( PIP ) , a marker of collagen type I synthesis , can be used to assess the ability of antihypertensive treatment to regress myocardial fibrosis in hypertensive patients . Methods and Results —The study was performed in 37 patients with essential hypertension and hypertensive heart disease . After r and omization , 21 patients were assigned to losartan and 16 patients to amlodipine treatment . At baseline and after 12 months , right septal endomyocardial biopsies were performed to quantify collagen volume fraction ( CVF ) on picrosirius red – stained sections with an automated image- analysis system . Serum PIP was measured by specific radioimmunoassay . Nineteen patients in the losartan group and 11 in the amlodipine group finished the study . Time-course changes in blood pressure during treatment were similar in the 2 groups of patients . In losartan-treated patients , CVF decreased from 5.65±2.03 % to 3.96±1.46 % ( P < 0.01 ) and PIP from 127±30 to 99±26 & mgr;g/L ( P < 0.01 ) . Neither CVF or PIP changed significantly in amlodipine-treated patients . CVF was directly correlated with PIP ( r = 0.44 , P < 0.001 ) in all hypertensives before and after treatment . Conclusions —These findings suggest that the ability of antihypertensive treatment to regress fibrosis in hypertensives with biopsy-proven myocardial fibrosis is independent of its antihypertensive efficacy . Our data also suggest that blockade of the angiotensin II type 1 receptor is associated with inhibition of collagen type I synthesis and regression of myocardial fibrosis in hypertensives . Thus , determination of serum PIP may be useful to assess the cardioreparative properties of antihypertensive treatment in hypertensives OBJECTIVE To evaluate the efficacy of the monotherapy of 15 agents in treating essential hypertension . METHODS After 2-week wash-out , a total of 370 patients with seated diastolic blood pressure 95 - 114 mmHg and seated systolic blood pressure < 180 mmHg were r and omized to different therapeutic groups .  24-hour ambulatory blood pressure monitoring was performed before medication and at the end of 8 weeks . RESULT All the agents significantly reduced the 24 hour mean blood pressures after treatment except doxazosin , terazosin , and torasemide . CONCLUSION The result suggested that the angiotensin-converting enzyme inhibitors , angiotensin II receptor blockers , beta-blockers and long-acting calcium antagonists were effective in treating essential hypertension , while the low-dose doxazosin , terazosin and torasemide can be used for combination therapy but not for monotherapy Objective Hypertension guidelines recommend initial treatment with a β-blocker or diuretic and adding the other drug where blood pressure is not controlled . We hypothesized that systematic rotation through the major classes of antihypertensive drugs would demonstrate substantial differences in the pattern of an individual patient 's response , and suggest a more rational approach to choosing best treatment . Design Thirty-four young hypertensives ( age 28–55 , median 47 ) rotated in a double-blind , Latin-square , crossover fashion through 6 weeks of treatment each with amlodipine , doxazosin , lisinopril , bisoprolol , bendrofluazide and placebo . Blood pressure was measured at each visit . ‘ Best ’ drug , defined by efficacy and tolerability , was repeated at the end . Results Rotation doubled the number of patients reaching target blood pressure ( systolic < 140 mmHg ) on one drug ( P = 0.03 ) . All five drugs were represented among the ‘ best ’ drugs . In six patients , the blood pressure on ‘ best ’ drug was at least 10 mmHg lower than on any other . Response to the ‘ best ’ drug was highly correlated ( r = 0.79 ) with its previous administration . By contrast , there were only weak correlations between responses to pairs of drugs , except for angiotensin-converting enzyme ( ACE ) inhibitor ( A ) with β-blocker ( B ) , and calcium blocker ( C ) with diuretic ( D ) – each r = 0.71 , P < 0.005 ) . In these young patients , the majority of patients ( 23/34 ) responded best to a drug suppressing the renin system ( A and B ) . Conclusions Patients vary reproducibly in their response to initial treatment , and switching among drugs can increase the efficacy of monotherapy . The results support an AB/CD scheme for choosing therapy , in which the first drug is taken from one of these pairs , and uncontrolled patients switch to one of the other pair
The effect of ARB on the improvement of the PWV level is not superior to other types of antihypertensive agents , but ARB is superior to other types of antihypertensive agents for improving the AI level .
Overall , to improve of arterial stiffness , ARB maybe is superior to other antihypertensive agents
BACKGROUND This system review and meta- analysis was conducted to systematic ally review and analyze the clinical benefits of different antihypertensive agents in improving arterial stiffness in hypertensive patients .