Related Experiment Videos
Comparative effects of antihypertensive drugs on systolic blood pressure
M M Chaignon1, J J Mourad, J Guédon
1Nephrology and Hypertension Department, Centre Médico-Chirurgical Foch, Suresnes, France.
Insights
Systolic blood pressure is a key cardiovascular risk factor in individuals over 50. Lacidipine and enalapril demonstrated superior systolic pressure reduction compared to nitrendipine in elderly hypertensive patients.
Area of Science:
- Cardiology
- Gerontology
- Pharmacology
Background:
- Systolic blood pressure is a critical cardiovascular risk factor in individuals over 50.
- Elderly hypertensive patients often exhibit sustained essential hypertension or isolated systolic hypertension.
Purpose of the Study:
- To compare the efficacy of lacidipine, nitrendipine, and enalapril in managing systolic hypertension in the elderly.
- To investigate the mechanisms of action of vasodilators on blood pressure and arterial compliance.
Main Methods:
- A multicenter, randomized, double-blind trial involving 278 elderly hypertensive patients.
- Comparison of supine systolic pressure reduction after 8 weeks of treatment with lacidipine, nitrendipine, and enalapril.
- Review of existing literature on vasodilator mechanisms, including effects on peripheral resistance and arterial compliance.
Main Results:
- Lacidipine and enalapril led to a greater reduction in supine systolic pressure than nitrendipine.
- The difference in systolic pressure reduction between lacidipine and nitrendipine was statistically significant.
- Other vasodilators like lisinopril and isosorbide dinitrate also showed effective systolic pressure reduction in elderly patients.
Conclusions:
- Lacidipine is an effective treatment for systolic hypertension in the elderly, showing superior efficacy to nitrendipine.
- Vasodilators can reduce systolic blood pressure by decreasing peripheral resistance and/or increasing arterial compliance.
- Calcium entry blockers and nitrates tend to improve arterial compliance.
Abstract:
Importance of systolic over diastolic blood pressure measurements: Systolic pressure is known to be a more important independent cardiovascular risk factor than diastolic pressure in subjects over 50 years of age; after that age, a high incidence of two types of systolic hypertension is observed, sustained essential hypertension with a disproportionate increase in systolic pressure and isolated systolic hypertension. Effects of lacidipine on blood pressure in the elderly: The effects of vasodilators on blood pressure have been studied extensively. Recently, lacidipine, nitrendipine and enalapril were compared in a multicenter, randomly allocated, double-blind trial in elderly hypertensive patients with a disproportionate increase in systolic pressure treated for 8 weeks (n = 278). In these patients, supine systolic pressure decreased to a greater extent with lacidipine and enalapril than with nitrendipine, the difference between lacidipine and nitrendipine reaching statistical significance. In another trial, lisinopril produced a greater reduction in systolic pressure than atenolol. Finally, in a study in elderly patients with systolic hypertension, long-acting isosorbide dinitrate induced a selective sustained decrease in systolic pressure. Mechanisms of action of vasodilators: A fall in systolic blood pressure may be produced by vasodilators through a reduction in peripheral resistance with or without an active change in arterial compliance. Dihydralazine-like substances do not increase arterial compliance whereas angiotensin converting enzyme inhibitors, calcium entry blockers and nitrates tend to increase arterial compliance for the same decrease in mean arterial pressure.