title: A controlled study of the effects of isosorbide mononitrate on arterial blood pressure and pulse wave form in systolic hypertension.
abstract: OBJECTIVE
  To determine the effect of an extended-release nitrate preparation on the arterial pulse wave and blood pressure of patients in whom systolic blood pressure was elevated in part by exaggerated pulse-wave reflectance.
  
  
  METHODS
  A double-blind randomized placebo-controlled crossover study was carried out.
  
  
  METHODS
  The subjects were ten elderly patients with systolic hypertension resistant to conventional anti-hypertensive therapy. Pharmacodynamic responses to 2-week courses of placebo/isosorbide mononitrate (ISMN) were assessed in seven subjects by an ambulatory blood pressure monitor, and in all ten subjects by standard sphygmomanometry, arterial pulse-wave analysis and measurement of plasma nitrate concentration during peak and trough.
  
  
  RESULTS
  Ambulatory systolic blood pressure was decreased by ISMN (P < 0.02) between 1000 and 2200 h. Ambulatory diastolic blood pressure fell with ISMN (P < 0.01) during the last 4 h of this period. At peak plasma nitrate levels, ISMN decreased the aortic systolic blood pressure (P < 0.01), ejection peak (P < 0.02) and augmentation component (P < 0.001) of the pulse wave; heart rate increased slightly (P < 0.03).
  
  
  CONCLUSIONS
  ISMN has a role as an adjunct in the anti-hypertensive therapy of patients with refractory systolic hypertension due to exaggerated pulse-wave reflectance.
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia. gstokes@med.usyd.edu.au
authors.forename: G S
authors.initials: GS
authors.lastname: Stokes
authors.forename: M
authors.initials: M
authors.lastname: Ryan
authors.forename: A
authors.initials: A
authors.lastname: Brnabic
authors.forename: G
authors.initials: G
authors.lastname: Nyberg
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D018592:Cross-Over Studies; D003971:Diastole / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood; D008297:Male; D013599:Systole / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000097:blood
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate