Differential Impacts of Antihypertensive Drugs on Central Blood Pressure and Their Clinical Significance

Yoshio      Matsui; Kazuomi      Kario

Abstract

Recent evidence suggests that central blood pressure (BP) is a more important determinant of cardiovascular risk than is brachial BP. Antihypertensive drugs with vasodilating properties have a more beneficial effect on central systolic BP and pulse pressure by decreasing arterial stiffness and/or the magnitude of wave reflections than thiazide diuretics and β-blockers. These differential effects of antihypertensive drugs on central BP have been shown to account for the differential effects on cardiovascular prognosis. Furthermore, it has been reported that vasodilating drugs, such as angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, could contribute to both the reduction of central systolic BP and the regression of left ventricular hypertrophy, mainly through a reduction of the magnitude of wave reflections. Further studies are needed to demonstrate whether a therapeutic strategy aiming at normalizing central systolic BP will be more effective than a strategy targeting brachial systolic BP in preventing cardiovascular events.

Keywords: Angiotensin converting enzyme inhibitor, angiotensin II receptor blocker, β-blocker, calcium channel blocker, central blood pressure, left ventricular mass, pulse wave velocity, reflection wave magnitude, thiazide diuretic