The effect of treatment with eprosartan on pulse pressure: factors predicting response.

Background: Pulse pressure is an important cardiovascular risk factor, particularly in the elderly and in patients with isolated systolic hypertension. The differential impact of antihypertensive agents on pulse pressure is not known.

Objective: To assess the antihypertensive effect of treatment with the angiotensin II receptor blocker eprosartan on pulse pressure, and the factors influencing this effect.

Methods: The present study was an observational study of 4067 patients (55% women, mean age 67 years) with essential hypertension, newly diagnosed or unresponsive to current treatment, in which 3133 patients received 12 weeks of treatment with eprosartan 600 mg/day (87% monotherapy) in primary care centres. Blood pressure was measured using a validated oscillometric device (Omron 705CP, Omron Healthcare Inc, USA).

Results: Eprosartan significantly reduced pulse pressure at 12 weeks (13.5 mmHg, P<0.001). The reductions in systolic, diastolic and mean blood pressures were also statistically significant (26.0 mmHg, 12.6 mmHg and 17.1 mmHg, respectively). After correcting the pulse pressure for hypertension severity (pulse pressure/mean blood pressure ratio), this index was reduced from 62% to 58% with eprosartan, suggesting a 4% reduction in the pulsatile component. This reduction was more pronounced in patients over 60 years of age, those with a higher index at baseline and those with hypertensive cardiovascular complications. Adverse drug reactions occurred in 1.5% of patients.

Conclusion: Eprosartan is an effective, well tolerated antihypertensive drug that reduces pulse pressure. This reduction is partially independent of the severity of high blood pressure, which may be important for both safety and target organ protection.