Elevated pulse pressure in treated hypertensive patients during 24-hour ambulatory blood pressure monitoring.

OBJECTIVES

We tested whether antihypertensive therapy may alter PP independently from other blood pressure parameters.

METHODS

Data from 24-hour ambulatory blood pressure monitoring (24-h ABPM) were compared between healthy normotensive controls and hypertensive subjects successfully treated (sBP/dBP 24-hour average bellow 130/80 mmHg) with antihypertensive medication either with absence (Treated) or presence of additional risk factors (Treated + R). These groups were compared with poorly treated hypertensives (sBP/dBP over 130/80 mmHg) with absence (Uncontrolled) or presence of additional risk factors (Uncontrolled + R). We studied mean 24-hour systolic and diastolic blood pressure (sBP and dBP), mean arterial pressure (MAP) and pulse pressure (PP).

RESULTS

In Treated and Treated + R groups, sBP and dBP were appropriately controlled by antihypertensive medication, however PP was significantly increased in both groups (49 +/- 1 mmHg and 51 +/- 2 mmHg, resp., in both p < 0.05) as compared to the controls (43 +/- 1 mmHg). In Uncontrolled and Uncontrolled + R groups, values of PP were even significantly higher (60 +/- 2 mmHg and 76 +/- 3, resp.) as compared to controls as well as to successfully treated groups (p < 0.05). PP was significantly positively correlated to sBP in all groups (p < 0.05), except Treated + R. Other parameters (age, body mass index, MAP) showed overall significant positive relationship only in pooled hypertensive population.

CONCLUSION

24-h ABPM revealed significantly increased PP, in spite of proper control of sBP and dBP in treated hypertensive patients. We propose that 24-h PP could provide additional information in the evaluation of antihypertensive therapy, even when depending on sBP (Tab. 3, Fig. 2, Ref. 39).