title: Chlorthalidone Plus Amiloride Reduces the Central Systolic Blood Pressure in Stage 1 Hypertension Patients.
abstract: BACKGROUND
  Hypertension reduction strategies use blood pressure in the brachial artery as the primary endpoint. Individuals who achieve the target blood pressure reduction with antihypertensive treatment have residual cardiovascular risk attributed to the difference in pressure between the aorta and brachial artery. Antihypertensive treatment affects the intrinsic properties of the vascular wall and arterial stiffness markers and consequently the central pressure. Recent publications stress the importance of adequate control of the central compared to peripheral blood pressure. Related clinical implications suggest that individuals with normal peripheral but high central blood pressure should not receive antihypertensive drugs that act on the central pressure. Therefore, they are at greater cardiovascular risk. The aim of the study was to evaluate the effect of treatment with a thiazide diuretic versus losartan on the central blood pressure in stage 1 hypertensive patients.
  
  
  METHODS
  Twenty-five patients were randomized to the chlorthalidone 25 mg/amiloride 5 mg group (q.d.) and 25 patients received losartan 50 mg (b.i.d). The central systolic blood pressure (CSBP) and augmentation index (AIx 75) were assessed using applanation tonometry. The pairedt-test was used to compare the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), CSBP and AIx 75 between the thiazide and losartan groups at baseline and after 6 months of treatment.
  
  
  RESULTS
  Significant reductions in CSBP (123.3 ± 14.2 vs. 113.4 ± 111.4, P = 0.0103) and AIx 75 (87.7 ± 9.6 vs. 83.8 ± 8.9, P = 0.0289) were observed after 6 months of drug treatment with chlorthalidone 25 mg/amiloride 5 mg (q.d.). The administration of losartan 50 mg (b.i.d) did not reduce the CSBP and there were insignificant changes in the AIx 75.
  
  
  CONCLUSIONS
  Six-month treatment of chlorthalidone/amiloride but not losartan reduces the CSBP and AIx 75 in adults with stage 1 hypertension.
authors.affiliation: Hypertension Clinic, Department of Internal Medicine, State Medical School of Sao Jose do Rio Preto (FAMERP), Sao Paulo, Brazil.
authors.forename: Leticia Aparecida Barufi
authors.initials: LA
authors.lastname: Fernandes
authors.affiliation: Hypertension Clinic, Department of Internal Medicine, State Medical School of Sao Jose do Rio Preto (FAMERP), Sao Paulo, Brazil.
authors.forename: Elizabeth do Espirito Santo
authors.initials: ED
authors.lastname: Cestario
authors.affiliation: Endocrinology Division of the Internal Medicine Department, State Medical School of Sao Jose Rio Preto, SP (FAMERP), Brazil.
authors.forename: Luciana Neves
authors.initials: LN
authors.lastname: Cosenso-Martin
authors.affiliation: Hypertension Clinic, Department of Internal Medicine, State Medical School of Sao Jose do Rio Preto (FAMERP), Sao Paulo, Brazil.
authors.forename: Jose Fernando
authors.initials: JF
authors.lastname: Vilela-Martin
authors.affiliation: Hypertension Clinic, Department of Internal Medicine, State Medical School of Sao Jose do Rio Preto (FAMERP), Sao Paulo, Brazil.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Yugar-Toledo
authors.affiliation: Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Flavio Danni
authors.initials: FD
authors.lastname: Fuchs
keywords: Amiloride; Central systolic blood pressure; Chlorthalidone; Losartan; Stage 1 hypertension