Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: Comparison with atenolol
Identifieur interne : 00B895 ( Main/Merge ); précédent : 00B894; suivant : 00B896Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: Comparison with atenolol
Auteurs : Gérard M. London [France] ; Roland G. Asmar [France] ; Michaël F. O'Rourke [Australie] ; Michel E. Safar [France]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2004.
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- Pascal (Inist)
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- topic : Homme.
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Abstract
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 populations, 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 randomized 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.
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Asmar</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>L'Institut Cardiovasculaire</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="O Rourke, Michael F" sort="O Rourke, Michael F" uniqKey="O Rourke M" first="Michaël F." last="O'Rourke">Michaël F. O'Rourke</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>St. Vincent Hospital</s1><s2>Darlinghurst</s2><s3>AUS</s3><sZ>3 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>St. Vincent Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Safar, Michel E" sort="Safar, Michel E" uniqKey="Safar M" first="Michel E." last="Safar">Michel E. 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London</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Fôpital Manhès</s1><s2>Fleuy-Mèrogis</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Fleuy-Mèrogis</wicri:noRegion><wicri:noRegion>Fôpital Manhès</wicri:noRegion><wicri:noRegion>Fôpital Manhès</wicri:noRegion></affiliation></author><author><name sortKey="Asmar, Roland G" sort="Asmar, Roland G" uniqKey="Asmar R" first="Roland G." last="Asmar">Roland G. Asmar</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>L'Institut Cardiovasculaire</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="O Rourke, Michael F" sort="O Rourke, Michael F" uniqKey="O Rourke M" first="Michaël F." last="O'Rourke">Michaël F. O'Rourke</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>St. Vincent Hospital</s1><s2>Darlinghurst</s2><s3>AUS</s3><sZ>3 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>St. Vincent Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Safar, Michel E" sort="Safar, Michel E" uniqKey="Safar M" first="Michel E." last="Safar">Michel E. Safar</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Hôtel-Dieu</s1><s2>Paris</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. 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Cardiol.</title><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antihypertensive agent</term><term>Arterial pressure</term><term>Atenolol</term><term>Blood pressure</term><term>Cardiology</term><term>Circulatory system</term><term>Comparative study</term><term>Diuretic</term><term>Human</term><term>Hypertension</term><term>Indapamide</term><term>Low dose</term><term>Low pressure</term><term>Mechanism</term><term>Perindopril</term><term>Phlebology</term><term>Reduction</term><term>Systolic pressure</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Hypertension artérielle</term><term>Mécanisme</term><term>Pression systolique</term><term>Pression sanguine</term><term>Pression artérielle</term><term>Basse pression</term><term>Réduction</term><term>Dose faible</term><term>Périndopril</term><term>Indapamide</term><term>Homme</term><term>Etude comparative</term><term>Aténolol</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Phlébologie</term><term>Antihypertenseur</term><term>Diurétique</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 populations, 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 randomized 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.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li></country><region><li>Île-de-France</li></region><settlement><li>Paris</li></settlement></list><tree><country name="France"><noRegion><name sortKey="London, Gerard M" sort="London, Gerard M" uniqKey="London G" first="Gérard M." last="London">Gérard M. London</name></noRegion><name sortKey="Asmar, Roland G" sort="Asmar, Roland G" uniqKey="Asmar R" first="Roland G." last="Asmar">Roland G. Asmar</name><name sortKey="Safar, Michel E" sort="Safar, Michel E" uniqKey="Safar M" first="Michel E." last="Safar">Michel E. Safar</name></country><country name="Australie"><noRegion><name sortKey="O Rourke, Michael F" sort="O Rourke, Michael F" uniqKey="O Rourke M" first="Michaël F." last="O'Rourke">Michaël F. O'Rourke</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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