title: Effects of antihypertensive drugs on central blood pressure in humans: a preliminary observation.
abstract: BACKGROUND
  Central blood pressure (BP) is considered a better predictor of cardiovascular events than brachial BP. Modifications of central, beyond brachial BP, can be assessed by pressure amplification, a potential new cardiovascular risk factor. Comparison between drugs' effect on central hemodynamics has been poorly studied. Our aim was to assess the hemodynamic effect of a 12-week treatment with amlodipine 5mg, or candesartan 8mg, or indapamide sustained-release 1.5mg, in comparison with placebo.
  
  
  METHODS
  We analyzed 145 out-patients with essential hypertension in primary prevention enrolled in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) study, a multicenter, randomized, double-blinded, placebo-controlled trial. Arterial stiffness, central BP, pressure amplification, and wave reflection were measured by applanation tonometry.
  
  
  RESULTS
  Baseline characteristics of patients were homogeneous between groups. After treatment, we found that active drugs produced similar reduction of both central and peripheral BPs, with no significant interdrug differences (all P < 0.05; excluded peripheral pulse pressure, compared with placebo). Second, amlodipine (1.9% ± 15.3%), candesartan (3.0% ± 14.6%) and indapamide (4.1% ± 14.4%) all increased pulse pressure amplification, but only indapamide was statistically different from placebo (P = 0.02). Finally, no significant changes were observed on pulse wave velocity, heart rate, and augmentation index.
  
  
  CONCLUSIONS
  The 3 antihypertensive drugs similarly reduced peripheral and central BP, as compared with placebo, but a significant increase in pulse pressure amplification was obtained only with indapamide, independently of arterial stiffness modifications.
  
  
  BACKGROUND
  3283161 by BIOPHARMA.
authors.affiliation: Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France.
authors.forename: Davide
authors.initials: D
authors.lastname: Agnoletti
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Jacques
authors.initials: J
authors.lastname: Blacher
authors.forename: Michel E
authors.initials: ME
authors.lastname: Safar
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001011:Aorta / Q000187:drug effects / Q000503:physiopathology; D062186:Arterial Pressure / Q000187:drug effects; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D001916:Brachial Artery / Q000187:drug effects / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D063177:Pulse Wave Analysis; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D017311:Amlodipine; D007190:Indapamide; C081643:candesartan
keywords: antihypertensive agents; arterial stiffness; blood pressure; central blood pressure; hypertension; pressure amplification; wave reflection.