Differential pulse pressure response to various antihypertensive drug families

Karpanou, Eva A.; Vyssoulis, Gregory P.; Stefanadis, Christodoulos; Cokkinos, Dennis V.

doi:10.1038/sj.jhh.1002069

Cited by 7 publications

(3 citation statements)

References 30 publications

(26 reference statements)

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“… 38 Using MR, the current study extends previous evidence by supporting that widened PP in later life represents an additional causal risk factor for ischemic stroke on top of the well-established effects of mean blood pressure. Given the differential effects of antihypertensive drug classes on PP, 19 , 20 , 39 our findings could have clinical implications for the optimal management of elevated blood pressure in later life. Indeed, our findings suggest that future clinical trials exploring the efficacy of blood pressure-lowering approaches for stroke prevention should also consider changes in PP.…”

Section: Discussionmentioning

confidence: 87%

Genetically Predicted Blood Pressure Across the Lifespan

Georgakis¹,

Malik²,

Protogerou

et al. 2020

Hypertension

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Hypertension is the leading risk factor for stroke. Yet, it remains unknown whether blood pressure pulsatility (pulse pressure [PP]) causally affects stroke risk independently of the steady pressure component (mean arterial pressure [MAP]). It is further unknown how the effects of MAP and PP on stroke risk vary with age and stroke cause. Using data from UK Biobank (N=408 228; 38–71 years), we selected genetic variants as instruments for MAP and PP at age ≤55 and >55 years and across age deciles. We applied multivariable Mendelian randomization analyses to explore associations with ischemic stroke, intracerebral hemorrhage, and their subtypes. Higher genetically predicted MAP was associated with higher risk of ischemic stroke and intracerebral hemorrhage across the examined age spectrum. Independent of MAP, higher genetically predicted PP only at age >55 years was further associated with higher risk of ischemic stroke (odds ratio per-SD-increment, 1.23 [95% CI, 1.13–1.34]). Among subtypes, the effect of genetically predicted MAP on large artery stroke was attenuated, whereas the effect of genetically predicted PP was augmented with increasing age. Genetically predicted MAP, but not PP, was associated with small vessel stroke and deep intracerebral hemorrhage homogeneously across age deciles. Neither genetically predicted MAP nor PP were associated with lobar intracerebral hemorrhage. Beyond an effect of high MAP at any age on ischemic and hemorrhagic stroke, our results support an independent causal effect of high PP at older ages on large artery stroke. This finding warrants further investigation for the development of stroke preventive strategies targeting pulsatility in later life.

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Section: Discussionmentioning

confidence: 87%

Genetically Predicted Blood Pressure Across the Lifespan

Georgakis¹,

Malik²,

Protogerou

et al. 2020

Hypertension

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“…However, a decrease in diastolic BP compromises coronary perfusion and thus favors myocardial ischemia, particularly in the presence of stenosis of the coronary arteries (34). Recent studies have attempted to lower hs-CRP and pulse pressure to prevent cardiovascular events using medications such as statins and renin-angiotensin system blockers (35,36). How- ever, hs-CRP-and pulse pressure-directed therapies do not yet exist.…”

Section: Discussionmentioning

confidence: 99%

Impact of C-Reactive Protein and Pulse Pressure Evaluated at the Start of Peritoneal Dialysis on Cardiovascular Events in the Course of Treatment with Peritoneal Dialysis

et al. 2010

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♦ BackgroundDespite a reduced number of infectious complications, cardiovascular (CV) mortality remains unchanged in peritoneal dialysis (PD) patients. The aim of this study was to evaluate the effects of high-sensitivity C-reactive protein (hs-CRP) and pulse pressure (PP) at the start of PD on the development of CV events (CVEs) in these patients.♦ MethodsThe study population was comprised of 291 patients that started PD between January 2003 and June 2008 and were treated for more than 6 months. Baseline clinical, biochemical, and echocardiographic data, indices of dialysis adequacy, and peritoneal transport rate were reviewed ret-respectively. The clinical outcome was the occurrence of a CVE.♦ ResultsMean duration of follow-up was 28 (range 6 – 70) months. A CVE was observed in 33 patients (11.3%). The 1-, 3-, and 5-year cumulative incidences of CVEs were 4.0%, 13.7%, and 27.5%, respectively. Although multiple variables were correlated with the prevalence of a CVE in the univariate analysis, hs-CRP, PP, and comorbidity remained significant after adjustment: hs-CRP: odds ratio (OR) 4.09 (1.53 – 10.95), p = 0.005; PP: OR 2.79 (1.26 – 6.17), p = 0.012. PP and hs-CRP, which were not intercorrelated in our data, combined adversely to increase the incidence of CVEs. The incidence of CVEs increased with the number of risk factors, which included high hs-CRP, high PP, and the presence of comorbidity (no risk factor, 0%; 1 risk factor, 1.5%; 2 risk factors, 30.8%; 3 risk factors, 53.9%).♦ ConclusionsOur study suggests that measurements of hs-CRP and PP at the start of PD may be helpful in predicting the development of CVEs in the course of treatment with PD.

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“…However, current antihypertensive drugs predominantly affect muscular arterioles, with substantially less impact on elastic conduit arteries, which contributes to treatment-resistant systolic hypertension. 15 Nonetheless, the recent Conduit Artery Function Evaluation study 16 suggests that arterial function may comprise a worthwhile treatment target. In the Conduit Artery Function Evaluation study, the improvement of central haemodynamic (central BP) indices after treatment was accompanied by reduced rate of cardiovascular events, independent of peripheral BP changes.…”

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confidence: 99%