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Nitrates as adjunct hypertensive treatment.

Gordon S Stokes1

  • 1gstokes@med.usyd.edu.au

Current Hypertension Reports
|April 8, 2006
PubMed
Summary
This summary is machine-generated.

Isolated systolic hypertension (ISH) in elderly patients can be challenging to manage. Adjuvant nitrate therapy effectively lowers pulse pressure by ablating arterial reflection waves.

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Area of Science:

  • Cardiology
  • Vascular Medicine
  • Geriatrics

Background:

  • Isolated systolic hypertension (ISH) is a significant risk factor for stroke and heart failure in the elderly.
  • ISH is often difficult to manage with standard antihypertensive therapies.
  • Arterial stiffness and endothelial dysfunction contribute to ISH and prominent arterial reflection waves.

Purpose of the Study:

  • To investigate the efficacy of adjuvant nitrate therapy in managing ISH.
  • To determine if nitrates can reduce pulse pressure by targeting arterial reflection waves.

Main Methods:

  • Analysis of arterial pulse-wave profiles in elderly patients with ISH.
  • Controlled trials using isosorbide mononitrate and isosorbide dinitrate.
  • Assessment of effects on systolic blood pressure and pulse pressure.

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Main Results:

  • Prominent reflection waves in ISH patients indicate potential benefit from nitrate therapy.
  • Nitrate therapy (isosorbide mononitrate, isosorbide dinitrate) significantly decreased systolic blood pressure and pulse pressure.
  • Efficacy of isosorbide mononitrate was maintained without significant nitrate tolerance.

Conclusions:

  • Adjuvant nitrate therapy is effective in reducing pulse pressure in elderly patients with ISH.
  • Nitrates act directly on the arterial wall, causing vasorelaxation and ablating reflection waves.
  • Isosorbide mononitrate shows sustained efficacy in ISH management.