Stress reactivity in responder and non-responder hypertensives treated with verapamil and enalapril.

Hypertension was found to be associated with sympathetic overdrive but it is still debated if the antihypertensive agents can differently affect the stress response in hypertensive subjects. Through a psychophysiological study, we evaluated the effect of verapamil (V) and enalapril (E), both as monotherapy and association. Office BP was successfully reduced (< 145/90 mmHg) in 11 patients treated with V (V-Resp) and in 10 patients treated with E (E-Resp). Both the drugs were prescribed in 9 patients (V+E) who did not sufficiently lower their blood pressure (N-Resp) with monotherapy. Patients performed three stressors (color word stroop, cold pressor and handgrip). Extracardiovascular and hemodynamic functions were measured during baseline, stress and recovery periods. The response was evaluated adding the changes occurred in every phase of the psychophysiological session. This was performed before run-in and after any modification of the therapeutic intervention. The emotional arousal (phrontalis muscular contraction, skin conductance, peripheral temperature) was reduced when BP was normal. No change in BP reactivity was found. HR response decreased in V-Resp and cardiac output increased in E-Resp while the vascular reaction was restrained in E-Resp and V-Resp. This was reduced also in N-Resp when they assumed V+E and normalized their arterial pressure. The findings indicate that the sympathetic reactivity may be modified by the therapy. In particular, verapamil restrained the cardiac stress response without lowering the cardiac output and was advantageously associated with enalapril to control the psychophysiological response in more resistant hypertensive patients.