title: Effect of angiotensin receptor blockade on central aortic systolic blood pressure in hypertensive Asians measured using radial tonometry: an open prospective cohort study.
abstract: BACKGROUND
  Central aortic systolic pressure (CASP) has been shown to be a stronger predictor of cardiovascular events than brachial blood pressure (BP). Different classes of drugs have differential effects on CASP and brachial BP. This open prospective cohort study aimed to observe changes in CASP (measured using radial tonometry) among hypertensive Asians after 12 weeks of treatment with valsartan, an angiotensin receptor blocker (ARB).
  
  
  METHODS
  Patients with treatment-naïve hypertension or uncontrolled hypertension who were on non-ARB therapy were eligible for inclusion. Patients with uncontrolled BP (i.e. ≥ 140/90 mmHg) received valsartan for 12 weeks. The patients' brachial systolic and diastolic BP (SBP and DBP), and CASP changes were monitored using the BPro® watch.
  
  
  RESULTS
  The mean age of the 44 enrolled patients was 35 years. At baseline, the mean BP and CASP were 150.2/91.4 ± 10.6/9.4 mmHg and 136.3 ± 12.2 mmHg, respectively. Valsartan reduced SBP, DBP and CASP by 14.9 ± 10.7 mmHg, 10.9 ± 8.4 mmHg and 15.3 ± 10.9 mmHg, respectively (all p < 0.001). Every 1.0-mmHg reduction in brachial SBP resulted in a 0.8-mmHg reduction in CASP (p < 0.001). A CASP cut-off of 122.5 mmHg discriminated between controlled and uncontrolled BP (sensitivity 74%, specificity 88%).
  
  
  CONCLUSIONS
  Using radial tonometry, we demonstrated good correlation between CASP and brachial SBP reductions after 12 weeks of treatment with valsartan in our study cohort. Correlation analysis between CASP and SBP reductions may be useful for demonstrating whether a drug is able to lower CASP beyond lowering SBP.
authors.affiliation: Department of General Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Hui Hwang
authors.initials: HH
authors.lastname: Teong
authors.affiliation: Department of General Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Adeline Mei Lin
authors.initials: AM
authors.lastname: Chin
authors.affiliation: Department of General Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Ashish Anil
authors.initials: AA
authors.lastname: Sule
authors.affiliation: Department of General Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Jam Chin
authors.initials: JC
authors.lastname: Tay
mesh_terms: D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology*; D001011:Aorta / Q000187:drug effects; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011945:Receptors, Angiotensin / Q000378:metabolism; D013599:Systole / Q000187:drug effects*; D000068756:Valsartan / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D011945:Receptors, Angiotensin; D000068756:Valsartan
keywords: BPro® watch; central aortic systolic blood pressure; radial tonometry; valsartan