Efficacy of various antihypertensive agents as evaluated by indices of vascular stiffness in elderly hypertensive patients. Effect of different antihypertensive drug classes on central aortic pressure. Comparison of two calcium blockers on hemodynamics, left ventricular mass, and coronary vasodilatory in advanced hypertension. ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. Comparison of the Effects of Antihypertensive Agents on Central Blood Pressure and Arterial Stiffness in Isolated Systolic Hypertension Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. Antihypertensive efficacy and side effects of three beta‐blockers and a diuretic in elderly hypertensives: a report from the STOP‐Hypertension study Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): Practical Implications Lack of difference between nebivolol/hydrochlorothiazide and metoprolol/hydrochlorothiazide on aortic wave augmentation and central blood pressure Stress management versus lifestyle modification on systolic hypertension and medication elimination: a randomized trial. Central versus peripheral blood pressure in malignant hypertension; effects of antihypertensive treatment. Impact of blood pressure control and angiotensin-converting enzyme inhibitor therapy on new-onset microalbuminuria in type 2 diabetes: a post hoc analysis of the BENEDICT trial. Ambulatory Blood Pressure and Left Ventricular Changes During Antihypertensive Treatment: Perindopril Versus Isradipine South African hypertension guideline 2011. Differential effects of beta-adrenoreceptor antagonists on central and peripheral blood pressure at rest and during exercise. Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension
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 Central aortic systolic blood pressure ( BP ) is an important determinant of cardiac workload and cardiac hypertrophy . The relationship of central aortic systolic BP and brachial BP varies depending on the stiffness of blood vessels . It is not certain whether the different drug classes affect the brachial and aortic systolic BP in a similar manner . In a double-blind crossover study , we measured the effects of the four major drug classes compared with placebo on central aortic pressure . Central aortic pressure and various indices were determined using the Sphygmo Cor apparatus . The study was undertaken in patients aged 65 to 85 years with systolic BP > 150 mm Hg at study entry . Results are reported for 32 patients who had satisfactory applanation tonometry in all five periods .  Calcium channel blockers and diuretics caused a greater fall in brachial artery systolic BP than angiotensin-converting enzyme ( ACE ) inhibitors or beta-blocking drugs . On placebo , central aorta augmentation pressure and index were 23 mm Hg and 33.3 % ; on ACE inhibitors the values were 18 mm Hg and 30 % ; on beta-blockers , 26 mm Hg and 38.5 % ; on calcium channel blockers , 16 mm Hg and 28 % ; and on diuretics , 17 mm Hg and 28.8 % . The augmentation pressure on beta-blocking drugs was greater than on the other three drug classes ( P < .05 ) , and augmentation pressures on ACE inhibitors , calcium channel blockers , and diuretics were less than on placebo ( P < .05 ) . The lowest central aortic pressures were achieved with calcium blocking drugs and diuretics . Therapy based on brachial artery recordings may thus overestimate the effect of beta-blocking drugs on central aortic systolic BP and underestimate the effectiveness of ACE inhibitors and calcium blocking drugs . The clinical importance of this discrepancy needs to be evaluated Dihydropyridine and nondihydropyridine calcium channel blockers ( CCB ) differ in pharmacologic characteristics . Few clinical studies distinguish effects of CCB as monotherapy . We conducted a comprehensive comparison of two CCB on patients with moderate to severe hypertension . Thirty patients with pretreatment diastolic blood pressures > or = 100 mm Hg were r and omly assigned to either nifedipine-GITS or verapamil-SR . Dose titration achieved a diastolic blood pressure of < or = 95 mm Hg or a decrease of > or = 15 mm Hg over 4 weeks . Clinic blood pressure ( BP ) , 24-h ambulatory BP , exercise BP , left ventricular mass , systolic and diastolic function by echocardiography , and coronary flow reserve by split-dose thallium-201 imaging  with adenosine were assessed at baseline , end of titration , 3 months and 6 months of treatment . Plasma renin activity , atrial natriuretic peptide , norepinephrine , and epinephrine were assayed . Both drugs caused similar reductions in clinic and 24-h ambulatory BP and similar reductions in left ventricular mass index . Compared to nifedipine-GITS , verapamil-SR produced a significantly lower resting and peak exercise heart rate .  Nifedipine-GITS elicited a lower peak exercise systolic BP . At end titration nifedipine-GITS produced lower plasma atrial natriuretic peptide levels , no longer apparent by 6 months . Plasma norepinephrine was lower with verapamil-SR , also at end titration and at 3 months , but not at 6 months . Plasma epinephrine and plasma renin activity were unchanged by either drug . There was no difference for systolic or diastolic left ventricular function or coronary flow reserve between the two treatments . Once daily nifedipine-GITS and verapamil-SR are equally effective for reduction of arterial pressure in moderate to severe hypertension . Differences in their hemodynamic profiles and neurohormonal responses are consistent with pre clinical pharmacologic characteristics . The clinical implication s of their similarities and differences remain to be fully evaluated in outcome studies The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure ( SBP ) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy . Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits . Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each . The study was a balanced , r and omized crossover design with five periods : placebo ; angiotensin converting enzyme inhibitors ; beta-blocking drugs ; calcium-blocking drugs ; and thiazide diuretics .  Blood pressure ( BP ) was measured 24 to 26 h after the previous dose . A question naire for side effects was administered at each visit . Seventy-four patients entered the study . beta-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods . There were 9 of 66 patients on P , 9 of 46 on beta-blockers , 4 of 65 on calcium-blocking drugs , 4 of 65 on diuretic , and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects . Decreases in SBP compared to r and omized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = beta-blockers 5 mm Hg . Blood pressure decrease correlated with placebo BP ( P < .0005 , r = 0.53 to 0.70 ) . When corrected for placebo , target SBP ( < 140 mm Hg ) was reached in between 6 % to 15 % of patients on monotherapy . Sequential monotherapy achieved target in 29 % . Angiotensin converting enzyme inhibitors , calcium-blocking drugs , and diuretics had no more side effects than placebo . Patients on beta-blockers had more side effects and the well-being score was reduced . Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure . beta-Blockers were relatively ineffective , were frequently contraindicated , and had more side effects . Monotherapy achieved control in only a small number of patients . In elderly people with essential hypertension , therapy should be instituted with diuretics or calcium-blocking drugs , but combination therapy will usually be required to achieve goal 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 OBJECTIVES The goal of this study was to determine if a low-dose combination of the angiotensin-converting enzyme inhibitor perindopril ( Per ) and the diuretic indapamide ( Ind ) reduces central ( thoracic aorta , carotid artery ) as well as brachial systolic blood pressure ( SBP ) more than the beta-blocker atenolol and to determine the hemodynamic factors influencing independently brachial and central SBP : pulse wave velocity ( PWV ) and pattern of wave reflections . BACKGROUND In high cardiovascular risk population s , angiotensin blockade improves survival without affecting brachial SBP and diastolic blood pressure ( DBP ) . Whether central SBP , which is physiologically lower than brachial SBP , is significantly reduced has never been investigated . METHODS This study was a double-blind r and omized trial for one year in patients with essential hypertension . RESULTS For a similar DBP reduction , Per/Ind decreased SBP significantly more than atenolol , with a more pronounced reduction for central than for brachial SBP . After one year , the difference between brachial and central SBP was maintained by Per/Ind ( 8.28 + /- 1.53 mm Hg ) and significantly attenuated by atenolol ( 0.29 + /- 1.61 mm Hg ) . Under atenolol , the principal factor modulating SBP reduction was mean blood pressure . Under Per/Ind , this parameter played a minor role , and the central SBP reduction implied a major role for disturbed PWV and wave reflections . CONCLUSIONS Under Per/Ind , but not atenolol , normalization of brachial SBP is achieved with a significantly greater reduction of central SBP . This hemodynamic profile reflects changes of wave reflections issued from distal arterial and arteriolar territory , where Per/Ind , but not atenolol , is known to improve vessel wall structure Objective : To compare the blood pressure‐lowering efficacy , the frequency of side effects and changes in laboratory values of three & bgr;‐blockers and a potassium‐sparing diuretic combination in elderly hypertensive patients . Design : The Swedish Trial in Old Patients with Hypertension ( STOP‐Hypertension ) was a prospect i ve , r and omized , double‐blind , multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70‐84 years . Methods : The study group consisted of 1627 elderly hypertensive patients ( mean ± SD age 75.7 ± 3.7 years ; 37 % males , 63 % females ) . Supine and st and ing blood pressure , heart rate and side effects were recorded at each visit . Blood was drawn for routine analysis . The mean length of follow‐up was 25 months ( range 6‐65 ) . No patient was lost to follow‐up . Results : After 2‐months ' single‐drug therapy , all four active drugs were found to be equally effective in reducing diastolic blood pressure ( DBP ) . However , there were differences in their efficacy in reducing systolic blood pressure ( SBP ) ; the diuretic was significantly more effective than the & bgr;‐receptor blockers . The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate . More than two‐thirds of the patients were given supplementary treatment , most of them already by the 2‐month visit , after which there was no significant difference in blood pressure among the treatment regimens . The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens . Conclusion : Metoprolol ( controlled release ) , atenolol , pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP . There were differences in their efficacy in reducing SBP , the diuretic being more effective than the & bgr;‐blockers . After addition of supplementary treatment ( & bgr;‐blocker to diuretic , or vice versa ) there were no significant differences in blood pressure reduction among the groups . The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens . Thus , the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs 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 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 vasodilating beta-blocker nebivolol is thought to be superior in lowering wave reflection and central blood pressure ( BP ) compared to nonvasodilating beta-blockers . The results from studies comparing nebivolol with either metoprolol or atenolol , with or without hydrochlorothiazide ( HCTZ ) , are not unequivocal . Methods : We examined the effects of nebivolol 5 mg and metoprolol 100 mg with HCTZ 12.5 mg on aortic wave augmentation , central BP and hemodynamics using a r and omized , double-blind , crossover design . We included 22 patients ( 17 men , age 59.9 ± 6.4 years ) with office SBP of 155 ± 16 mmHg and DBP of 93 ± 10 mmHg .  Radial applanation tonometry and noninvasive , continuous finger arterial BP measurement was performed at baseline and after 4 weeks of treatment with either drug regimen , separated by a 4-week washout period . Results : Neither treatment affected aortic wave augmentation significantly . Augmentation index increased 1.0 ± 7.8 % ( P = 0.5 ) for nebivolol/HCTZ and 2.4 ± 6.6 % ( P = 0.07 ) for metoprolol/HCTZ . Nebivolol/HCTZ lowered central SBP by 15.8 ± 14.9 mmHg and DBP 10.5 ± 8.4 mmHg , and with metoprolol/HCTZ by 13.5 ± 12.3 mmHg for SBP and 9.5 ± 6.8 mmHg for DBP ( all P < 0.001 ) . Heart rate was lowered 8.1 ± 5.4 beats/min by nebivolol/HCTZ and 8.6 ± 4.9 beats/min by metoprolol/HCTZ . Peripheral BP was reduced to a similar extent as central BP . Peripheral BP decreased by 16.3 ± 14.9 mmHg systolic and 10.1 ± 8.2 mmHg diastolic with nebivolol/HCTZ , and by 15.2 ± 13.0 mmHg systolic and 9.1 ± 6.9 mmHg diastolic with metoprolol/HCTZ . Both treatment modalities had a similar effect on stroke volume , cardiac output , left-ventricular contractility and peripheral resistance . Conclusion : Nebivolol was not superior to metoprolol in reducing aortic wave augmentation or central BP when combined with HCTZ Isolated systolic hypertension is common in the elderly , but decreasing systolic blood pressure ( SBP ) without lowering diastolic blood pressure ( DBP ) remains a therapeutic challenge . Although stress management training , in particular eliciting the relaxation response , reduces essential hypertension its efficacy in treating isolated systolic hypertension has not been evaluated . We conducted a double-blind , r and omized trial comparing 8 weeks of stress management , specifically relaxation response training ( 61 patients ) , versus lifestyle modification ( control , 61 patients ) . Inclusion criteria were > or=55 years , SBP 140 - 159 mm Hg , DBP < 90 mm Hg , and at least two antihypertensive medications . The primary outcome measure was change in SBP after 8 weeks . Patients who achieved SBP < 140 mm Hg and > or=5 mm Hg reduction in SBP were eligible for 8 additional weeks of training with supervised medication elimination . SBP decreased 9.4 ( st and ard deviation [ SD ] 11.4 ) and 8.8 ( SD 13.0 ) mm Hg in relaxation response and control groups , respectively ( both ps < 0.0001 ) without group difference ( p=0.75 ) . DBP decreased 1.5 ( SD 6.2 ) and 2.4 ( SD 6.9 ) mm Hg ( p=0.05 and 0.01 , respectively ) without group difference ( p=0.48 ) . Forty-four ( 44 ) in the relaxation response group and 36 in the control group were eligible for supervised antihypertensive medication elimination . After controlling for differences in characteristics at the start of medication elimination , patients in the relaxation response group were more likely to successfully eliminate an antihypertensive medication ( odds ratio 4.3 , 95 % confidence interval 1.2 - 15.9 , p=0.03 ) . Although both groups had similar reductions in SBP , significantly more participants in the relaxation response group eliminated an antihypertensive medication while maintaining adequate blood pressure control BACKGROUND Sodium nitroprusside ( SNP ) and labetalol are recommended for the immediate treatment of malignant hypertension . Both are intravenous agents but have different effects on systemic hemodynamics , and may have differential effects on pulse-wave reflection and pulse-pressure amplification , with consequences for peripheral versus central blood pressures ( BPs ) . METHODS We conducted a nonr and omized , open-label study of 8 patients treated with sodium nitroprusside ( mean age ( ±SD ) , 44±14 years ; 6 males ; diastolic/systolic BP , 225±22/135±8 mm Hg ) and 6 patients treated with intravenous labetalol ( mean age , 39±15 years ; 4 males ; systolic/diastolic BP , 232±22/138±17 mm Hg ) before and after treatment for malignant hypertension , aim ing at a 25 % reduction in mean arterial pressure . We measured peripheral pressures with an intra-arterial catheter in the radial artery and derived central pressures with a generalized transfer filter . RESULTS Mean arterial pressure was similarly reduced with sodium nitroprusside and labetalol ( by 27 % and 30 % , respectively ; P = 0.76 ) . There was a nonsignificantly greater reduction in peripheral systolic blood pressure ( SBP )  with labetalol than with sodium nitroprusside ( 29±11 % vs. 18±7 % , P = 0.08 ) . The decline in peripheral diastolic blood pressure ( DBP ) with the two agents was comparable , whereas the reduction in peripheral pulse pressure was 8±16 % with SNP and 33±17 % with labetalol ( P = 0.01 ) . The decline in reflection magnitude was greater with SNP than with labetalol . There were no significant differences in the reduction of central BP  with SNP and labetalol . The amplification of PP increased with SNP but did not change with labetalol . CONCLUSIONS We found no difference in central SBP or PP in subjects treated with SNP and labetalol , but labetalol produced a greater reduction in peripheral SBP and PP in the immediate treatment of malignant hypertension For assessment of the independent renoprotective effect of BP control and angiotensin-converting enzyme inhibitor ( ACEi ) therapy , the relationships of baseline BP , BP reduction , and follow-up BP with the incidence of persistent microalbuminuria were evaluated in 1204 hypertensive patients who had type 2 diabetes and normoalbuminuria and were included in the BErgamo Nephrologic Diabetic Complications Trial ( BENEDICT ) study and were r and omly assigned to 3.6 yr of treatment with the ACEi tr and olapril ( 2 mg/d ) , the nondihydropyridine calcium channel blocker ( ndCCB ) verapamil SR ( 240 mg/d ) , their fixed combination Veratran ( tr and olapril 2 mg/d plus verapamil SR 180 mg/d ) , or placebo , plus other antihypertensive medications targeted at systolic/diastolic BP < 130/80 mmHg . Follow-up ( from month 3 to study end ) systolic , diastolic , mean , and pulse BP and their reductions versus baseline -- but not baseline BP -- independently predicted ( P < 0.001 ) the risk for microalbuminuria . In patients with follow-up BP above medians , ACEi significantly reduced the risk for microalbuminuria to levels that were observed among patients with BP below medians , regardless of ACEi treatment . The same trend was observed among patients with BP reductions below medians . ndCCB therapy did not independently affect microalbuminuria . Patients who were on Veratran had lower BP and less frequently received diuretics , beta blockers , or dihydropyridine dCCB . In hypertensive , normoalbuminuric patients with type 2 diabetes , BP reduction and ACEi therapy both independently may prevent microalbuminuria .  ACEi therapy is particularly effective when BP is poorly controlled , whereas ndCCB therapy is ineffective at any level of achieved BP . As compared with tr and olapril , Veratran may help with achievement of target BP with less need for concomitant antihypertensive medications Using digitized M-mode echocardiograms and 24-h ambulatory blood pressure ( BP ) monitoring , we compared the effects on left ventricle ( LV ) and BP of 6-month treatment with a calcium antagonist or an angiotensin-converting enzyme ( ACE ) inhibitor in 36 hypertensive patients with LV hypertrophy ( group 1 , 18 subjects treated with sustained-release isradipine ; group 2 , 18 subjects treated with perindopril ) . At the basal evaluation , the two groups had comparable BP and LV parameters . After treatment , both groups showed a similar and significant reduction in 24-h , day- and night-systolic and diastolic BP ( SBP , DBP ) . The reduction in LV mass index was greater ( p < 0.01 ) in group 2 . In group 1 , percentage of decrease of LV mass correlated significantly with percentage of decrease in 24-h and daytime BP ; this was not true of group 2 . Together with the reduction in LV hypertrophy , there was a significant increase of peak lengthening rate of LV diameter that was greater ( p < 0.01 ) in group 1 . Both drugs can reduce LV hypertrophy and improve diastolic function . The reduction of hypertrophy induced by perindopril appears to be partly independent of BP decrease and therefore partly related to a direct action of perindopril on the myocardium OUTCOMES Extensive data from r and omised controlled trials have shown the benefit of treating hypertension . The target blood pressure ( BP ) for antihypertensive management is systolic < 140 mmHg and diastolic < 90 mmHg with minimal or no drug side-effects ; however , stricter BP control is required for patients with end-organ damage , co-existing risk factors and co-morbidity , e.g. diabetes mellitus . The reduction of BP in the elderly and in those with severe hypertension should be achieved gradually over 1 month . Co-existent risk factors should also be controlled . BENEFITS Benefits of management include reduced risks of stroke , cardiac failure , chronic kidney disease and coronary heart disease . RECOMMENDATIONS The correct BP measurement procedure is described , and evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated . The total cardiovascular disease risk profile should be determined for all patients to inform management strategies . Lifestyle modification and patient education are cornerstones in the management of every patient . Major indications , pre caution s and contra-indications to each recommended antihypertensive drug are listed . Combination therapy should be considered ab initio if the BP is ≥ 20/10 mmHg . First-line drug therapy for uncomplicated hypertension includes low-dose thiazide-like diuretics , calcium channel blockers ( CCBs ) or angiotensin-converting enzyme inhibitors ( ACE-Is ) ( or ARBs - angiotensin II receptor blockers ) . If the target BP is not obtained , a second antihypertensive should be added from the aforementioned list . If the target BP is still not met , the third remaining antihypertensive agent should be used . In black patients  either thiazide-like diuretics or CCBs can be used initially , because response rates are better than with ACE-Is or β-blockers . In treating resistant hypertension , a central ly acting drug , vasodilator , α-blocker , spironolactone or β-locker should be added . This guideline includes management of specific situations , i.e. hypertensive emergency and urgency , severe hypertension with target organ damage , hypertension in diabetes mellitus , resistant hypertension , fixed drug combinations , new trials in hypertension , and interactions of antihypertensive agents with other drugs . VALIDITY The guideline was developed by the Southern African Hypertension Society BACKGROUND Differential effects of beta-adrenoreceptor antagonists ( beta-ARB ) on central and peripheral blood pressure may relate to change in heart rate and /or vasodilator tone and thus be exaggerated during exercise . AIMS To examine acute effects of selective and nonselective beta-ARB on central and peripheral blood pressure , cardiac output and peripheral vascular resistance during exercise . METHODS Healthy volunteers ( n= 20 , 18 men , 19 - 54 years ) received propranolol 80 mg , bisoprolol 20 mg , and placebo 1 h before bicycle ergometry ( 50 , 75 and 100 W each for 3 min ) in a r and omized , cross-over study . Cardiac output was determined by pulmonary uptake of soluble and inert gas tracers ( InnoCor , Innovision ) . Central systolic blood pressure ( SBP ) was determined from the late systolic shoulder of the digital artery pressure waveform ( Finometer , Finopres ) . RESULTS At rest , both beta-ARB reduced brachial but not central SBP ( compared with placebo ) . During exercise , beta-ARB reduced brachial SBP ( reductions of 19.9 + /- 4.3 mmHg and 23.2 + /- 2.7 mmHg for propranolol and bisoprolol , respectively , at 100 W , each P < 0.0001 ) but not central SBP . The difference between peripheral and central SBP was reduced , relative to that during placebo , by 21.5 mmHg ( 95 % confidence interval 8.8 , 34.1 ) and 26.4 mmHg ( 18.1 , 34.8 ) for propranolol and bisoprolol , respectively , at 100 W ( each P < 0.01 ) . There was no significant effect of beta-ARB on diastolic blood pressure or peripheral vascular resistance . CONCLUSIONS Despite reducing brachial blood pressure , acute beta-adrenoreceptor blockade in man at rest and during exercise does not reduce central blood pressure & NA ; We aim ed to investigate for the first time the blood pressure (BP)–lowering effect of renal sympathetic denervation ( RDN ) versus clinical ly adjusted drug treatment in true treatment-resistant hypertension ( TRH ) after excluding patients with confounding poor drug adherence . Patients with apparent TRH ( n=65 ) were referred for RDN , and those with secondary and spurious hypertension ( n=26 ) were excluded . TRH was defined as office systolic BP ( SBP ) > 140 mm Hg , despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic . In addition , ambulatory daytime SBP > 135 mm Hg after witnessed intake of antihypertensive drugs was required , after which 20 patients had normalized BP and were excluded . Patients with true TRH were r and omized and underwent RDN ( n=9 ) performed with Symplicity Catheter System versus clinical ly adjusted drug treatment ( n=10 ) . The study was stopped early for ethical reasons because RDN had uncertain BP-lowering effect . Office SBP and diastolic BP in the drug-adjusted group changed from 160±14/88±13 mm Hg ( ±SD ) at baseline to 132±10/77±8 mm Hg at 6 months ( P<0.0005 and P=0.02 , SBP and diastolic BP , respectively ) and in the RDN group from 156±13/91±15 to 148±7/89±8 mm Hg ( P=0.42 and P=0.48 , SBP and diastolic BP , respectively ) . SBP and diastolic BP were significantly lower in the drug-adjusted group at 6 months ( P=0.002 and P=0.004 , respectively ) , and absolute changes in SBP were larger in the drug-adjusted group ( P=0.008 ) . Ambulatory BPs changed in parallel to office BPs . Our data suggest that adjusted drug treatment has superior BP lowering effects compared with RDN in patients with true TRH . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier :
In conclusion , NVBBs , but not VBBs , determine a lower reduction in cSBP than in pSBP .
However , the difference in treatment-induced SBP amplification changes between NVBB and VBB is nearly abolished after accounting for differences in heart rate changes
β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure ( cSBP ) as compared with peripheral SBP ( pSBP ) .
Whether this effect is less pronounced with vasodilating β-blockers ( VBB ) when compared with nonvasodilating β-blockers ( NVBB ) remains unsettled .