title: Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension.
abstract: Increased blood pressure variability (BPV) contributes to end-organ damage, cardiovascular events and mortality associated with hypertension. In a cohort of 2780 hypertensive patients treated by either calcium channel blockers (CCBs), diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or β-blockers alone or in combination, we compared indices of short-term BPV according to the different treatments. Short-term BPV was calculated as the standard deviation (s.d.) of 24 h, daytime or nighttime systolic blood pressure and diastolic blood pressure (SBP and DBP). Short-term BPV was compared between patients treated with a given antihypertensive class of interest (alone or in combination) and those not treated with this class, after controlling for ambulatory average blood pressure, heart rate, age, gender, propensity scores and carotid-femoral pulse wave velocity. Patients treated with CCBs (n=1247) or diuretics (n=1486) alone, or in addition to other drugs had significant lower s.d. of 24-h SBP compared with those not treated with these classes (mean differences in s.d. -0.50±0.50 mm Hg, P=0.001 and -0.17±0.15 mm Hg, P=0.05, respectively). There was no significant difference regarding treatment with or without ARBs, ACEIs and β-blockers. The combinations of CCBs with diuretics or ARBs on top of other treatments resulted in a lower 24-h SBP variability (mean differences in s.d. -0.43±0.17 mm Hg, P=0.02 and -0.44±0.19 mm Hg, P=0.005 vs. other combination uses, respectively). Antihypertensive drug classes have differential effects on short-term BPV with a greater reduction in patients treated with CCBs and diuretics. The combinations of CCBs with diuretics may be the most efficient treatments in lowering BPV.
authors.affiliation: 1] Department of Clinical Pharmacology, AP-HP, H.Mondor-A.Chenevier hospital, Créteil, France [2] Paris-Est University, Faculté de Médecine, Créteil, France [3] Neuropsychologie Interventionnelle, INSERM U955, Créteil, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Levi-Marpillat
authors.affiliation: 1] Department of Clinical Pharmacology, AP-HP, H.Mondor-A.Chenevier hospital, Créteil, France [2] Paris-Est University, Faculté de Médecine, Créteil, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Macquin-Mavier
authors.affiliation: Fédération de Cardiologie, Créteil, France.
authors.forename: Anne-Isabelle
authors.initials: AI
authors.lastname: Tropeano
authors.affiliation: 1] Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy [2] Department of Health Sciences, University of Milano-Bicocca, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.affiliation: 1] Department of Clinical Pharmacology, AP-HP, H.Mondor-A.Chenevier hospital, Créteil, France [2] Paris-Est University, Faculté de Médecine, Créteil, France [3] Neuropsychologie Interventionnelle, INSERM U955, Créteil, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Maison
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification* / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology*; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000502:physiology; D015331:Cohort Studies; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics