[Comparative effects of angiotensin converting enzyme inhibitors and calcium antagonists on pulse pressure and blood pressure variability, based on ambulatory measurements in 236 mild to moderate hypertensive patients].

Objective: this retrospective study was aimed: at comparing the effects of angiotensin converting enzyme inhibitors (ACEI) and those of calcium antagonists (CA) on the pulse pressure of mild to moderate hypertensive patients; at assessing whether these effects were associated with some modifications of blood pressure variability or not.

Methods: the ambulatory blood pressure (ABP) recordings of 236 patients who previously entered clinical trials with a mean run-in placebo period of 2 weeks and a mean active treatment phase of 6 weeks (ACEI, n = 115; CA, n = 121) were reviewed. Baseline ABP has been analysed both as a continuous variable and as a categorical one (high when > 139/87 mmHg, low otherwise). Pulse pressure was calculated by the difference systolic ABP-diastolic ABP, whereas BP variability was estimated by the standard deviation and the variation coefficient of each recording. The results are given as percentage (mean +/- standard deviation). In the patients with high baseline systolic ABP, ACEI and CA did not significantly differ regarding their effects on pulse pressure (-11.1 +/- 17.2 vs -6.3 +/- 14.0, NS). By contrast, in the other patients, pulse pressure was lowered to a significantly greater degree by ACEI than by CA (-5.5 +/- 18.7 vs +1.8 +/- 18.8, p = 0.04). These differences were not related to baseline diastolic ABP. No difference at all was found with regard to BP variability which was altered by none of the drugs. In conclusion, pulse pressure, a reliable indicator of arterial compliance, seemed to be more decreased by ACEI than by CA, the difference being significant only in patients with apparent hypertension.