Advantages of blood pressure optimization.
Lowering blood pressure (BP) reduces cardiovascular events, but aggressive BP management may not be advantageous. Optimal BP control (target: <120/80 mm Hg) and conventional BP control (target: <140/90 mm Hg) were compared in patients with hypertension in terms of target-organ damage and tolerability. A total of 23 patients with hypertension were randomly assigned to optimal versus conventional therapy for 6 months. Therapy was initiated with lercanidipine 10 mg/day. For BP control, the dose could be doubled or other drugs added. Three indices of target-organ damage were studied: left ventricular mass (LVM) index, flow-mediated dilatation (FMD) of the brachial artery, and 24-hour urinary albumin excretion. The BP decreased markedly by 21.3+/-3.4/13.2+/-1.7 mm Hg in the conventional therapy group and by 26.6+/-3.6/17.9+/-1.5 mm Hg in the optimal therapy group. Diastolic BP was significantly lower, by 4.7+/-2.3 mm Hg, in the optimal therapy group (P<.05). Ambulatory BP was also decreased in both groups. There was no significant change in LVM or FMD in either group. Baseline LVM index and FMD values were correlated with systolic BP (r=0.51, P=.02; r=0.54, P=.009). In the optimal therapy group, urinary albumin excretion increased significantly (P=.04). Plasma levels of B-type natriuretic peptide (BNP) decreased with antihypertensive therapy (P=.03). Treatment was well tolerated, and none of the patients withdrew from the study. There was no significant difference in adverse events between the 2 groups. Optimization of BP is feasible, safe, and well tolerated; however, a larger study of longer duration may be needed to demonstrate improvements in LVM and endothelial function with conventional versus optimal therapy.
Cheung
Bernard M Y
BM
Department of Medicine, University of Hong Kong, Hong Kong.
Manil
Yu Bun
YB
Tse
Hung Fat
HF
Kumana
Cyrus R
CR
Lau
Chu-Pak
CP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D004095:Dihydropyridines / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
D000959:Antihypertensive Agents; D004095:Dihydropyridines; C060343:lercanidipine