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Diuretics Appear To Reduce Pulse Pressure Effectively In Older Hypertensive Patients

In a nationally representative sample of subjects older than 72 years, patients with hypertension who were treated with diuretics alone or in combination with beta-blockers had a lower mean pulse pressure than did those taking beta-blockers alone, report researchers.

Widening of the pulse pressure, the arithmetic difference between systolic and diastolic blood pressure, is common after the age of 60 years and has been shown to be a predictor of cardiovascular events in the elderly, even after adjustment for blood pressure level.

Although differences among classes of antihypertensive medications in their effects on systolic and diastolic blood pressure have been demonstrated by previous studies, their relation to pulse pressure is not clearly defined.

To examine the associations between antihypertensive medication class and the magnitude of pulse pressure among persons receiving hypertension treatment in the third National Health and Nutrition Examination Survey, Joseph J. Chang, MD, MPH, of New York Medical College, United States, and colleagues analysed cross-sectional data on 1429 elderly subjects reporting use of 1 or 2 hypertensive drugs.

All patients were aged 60 years or older, and were taking medication from one or more commonly prescribed classes, including beta-blockers, diuretics, calcium channel blockers, and angiotensin converting enzyme inhibitors.

Overall, no significant pulse pressure difference was found for any drug class when compared with the referent beta-blocker group after adjustment for covariates, including mean arterial pressure.

Mean pulse pressure was found to be lower in men than in women, in younger than in older subjects (over 72 years), and in blacks than in whites. The majority of patients (64%) reported use of only 1 antihypertensive medication, with diuretics being the most common single drug (25%).

In a subgroup analysis stratified by median age, mean pulse pressure was lower in subjects older than 72 years who used diuretics alone or in combination with beta-blockers than in those who used beta-blockers alone.

Additionally, subgroup analyses stratified by sex showed that mean pulse pressure was lower among men taking ACE inhibitors alone or in combination with diuretics, as compared with the reference beta-blocker group, suggesting that ACE inhibitors may be more effective in men in lowering pulse pressure than in women.

"These findings lend support to recommendations for use of diuretics in older hypertensive patients," researchers conclude.


Am J Med 2003 Nov;115:7:536-42. "Antihypertensive medication class and pulse pressure in the elderly: analysis based on the third National Health and Nutrition Examination Survey"

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