Pulse pressure monitoring of open antihypertensive therapy

BACKGROUND: Pulse pressure (PP) >60 mm Hg is an independent predictor of cardiovascular (CV) risk. Controlled studies showed that, unlike systolic and diastolic blood pressure (BP), PP responds minimally to placebo or no treatment. METHODS: The aim of this study was to evaluate PP as a parameter of BP control in general practice. This open multicenter study involved 1841 primary care physicians with postinclusion visits at months 3, 6, and 9. Six thousand one hundred ten hypertensive patients participated in this study. They had a baseline PP >60 mm Hg and were divided into five antihypertensive therapy categories: 1) no antihypertensive therapy; 2) antihypertensive therapy incorporating neither an angiotensin-converting enzyme inhibitor (ACEI) nor a diuretic; 3) ACEI but no diuretic; 4) diuretic but no ACEI; and 5) ACEI + diuretic. In each category, any other antihypertensive agent could be added to lower the PP below 60 mm Hg. The PP was calculated from systolic and diastolic BP using a semiautomatic oscillometric sphygmomanometer; new CV events were assessed. RESULTS: At 9 months, 95% of patients were receiving the ACEI + diuretic combination versus <10% at inclusion. During this period PP decreased below 60 mm Hg in 48% of the patients, and persisted above 80 mm Hg in less than 5%. New CV events occurred in 221 patients and were predicted by a positive CV history and age <50 years (odds ratio [OR]: 2.49; 95% confidence interval [CI]: 1.46-4.55). In patients without a CV history, the only predictor of decreased CV events was ACEI + diuretic combination (OR: 0.50; 95% CI: 0.30-0.90). In the overall population, age <50 years and PP <60 mm Hg predicted a lack of new CV events (OR: 0.55; 95% CI: 0.32-0.88). CONCLUSIONS: The PP is an appropriate tool for evaluating open chronic antihypertensive therapy, and help to predict, under an ACEI + diuretic combination, the occurrence of new CV events.