Cross-sectional characterization of all classes of antihypertensives in terms of central blood pressure in Japanese hypertensive patients

Background: Central blood pressure (CBP) has been reported to be superior to brachial blood pressure (BP) as a cardiovascular risk predictor in hypertensive patients; however, the effects of antihypertensives on CBP have not been fully examined. This cross-sectional hypothesis-generating study aimed to tentatively characterize all classes of antihypertensives in relation to CBP. Methods: Calibrated tonometric radial artery pressure waveforms were recorded using an automated device in 1,727 treated hypertensive patients and 848 nonhypertensive (non-HT) participants. Radial artery late systolic BP (SBP) has been reported to reflect central SBP. The difference between late and peak SBPs (ΔSBP2) was assessed with linear regression model-based adjustments. Separate regression models for ΔSBP2 were constructed for both participant groups as well as specified sub-populations. Results: ΔSBP2 was 3.3mmHg lower in patients treated with any single-vasodilating (VD) antihypertensive agent without significant interclass difference than with non-VD agents, and was 2.0mmHg lower than estimated in nonhypertensive subjects. Combinations of two vasodilators were 6.6 and 2.9mmHg lower in ΔSBP2 than nonvasodilator combinations and nonhypertensive subjects, respectively (P 0.001 for all comparisons). Nonvasodilators and their combination showed high ΔSBP2, 1.1 and 3.7mmHg higher than in nonhypertensive subjects (P 0.001 for both). Additional adjustment of the pulse rate reduced high ΔSBP2 with Β-blockers (ΒBLs). Conclusions: This cross-sectional observation suggests that vasodilatory antihypertensives lower CBP independently of peripheral BP levels without evident class-specific differences, whereas nonvasodilators may raise CBP.