Long-term effects of intensive blood-pressure lowering on arterial wall stiffness in hypertensive patients

Aortic stiffness is assessed by pulse wave velocity (PWV) and predicts the cardiovascular morbidity and mortality of hypertensive patients. To determine the long-term effects of intensive blood pressure (BP) lowering by antihypertensive drug therapy on aortic stiffness assessed by PWV, a single-blind randomized prospective study was performed.

One hundred forty nondiabetic hypertensive patients (67.6 +/- 0.9 years old; systolic/diastolic BP: 177 +/- 1/101 +/- 1 mm Hg) were assigned to an intensive control group (IC) with a target BP of <130/85 mm Hg (n = 71) or a moderate control group (MC) with a target BP of <140/90 mm Hg (n = 69), and aortic stiffness was assessed every 3 months by measuring aortic PWV with a pulse pressure analyzer.

During the 12-month treatment period, BP significantly decreased to 129 +/- 1/78 +/- 1 mm Hg and 152 +/- 2/87 +/- 1 mm Hg in the IC and MC, respectively. At the beginning of the study, PWV in the IC and MC was similar, averaging 1779 +/- 41 and 1885 +/- 50 cm/sec, respectively. By the end of the treatment period, however, PWV had decreased to 1621 +/- 34 cm/sec in the IC, but had not changed significantly in the MC. In the IC, the ratio of the change in PWV to the change in BP increased with the duration of BP lowering. Clinical and biological parameters were similar in both groups, except that higher doses of amlodipine were used in the IC.

Long-term intensive BP lowering in the hypertensive patients was associated with a significant reduction in aortic stiffness distinct from its acute depressor effect.