Peripheral large arteries and the response to antihypertensive treatment

Since systolic pressure is governed by the rate of ventricular ejection and the rigidity of the aortic wall, antihypertensive agents may have different effects on systolic and diastolic pressure. Despite an adequate decrease in diastolic pressure, systolic pressure may remain elevated due to structural alterations of large arteries. In the present study, a procedure is described to distinguish the dilation of small and large arteries. The former is evaluated from the calculation of forearm resistance and the latter from the determination of the arterial diameter of the brachial artery, using a bidimensional pulsed Doppler system. Nitroglycerin dilates the brachial artery, with no change in forearm resistance. Dihydralazine reduces the diameter of the brachial artery but decreases forearm resistance. Only calcium and converting-enzyme inhibitors dilate both small and large arteries and cause an increase in brachial blood flow.