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Differential Effects Between a Calcium Channel Blocker and a Diuretic When Used in Combination With Angiotensin II Receptor Blocker on Central Aortic Pressure in Hypertensive Patients
Hypertension, 08/13/09

Matsui Y et al. – The data showed that the combination of olmesartan and azelnidipine had a more beneficial effect on central systolic BP and arterial stiffness than the combination of olmesartan (20.0 mg) and hydrochlorothiazide, despite the lack of a significant difference in brachial systolic BP reduction between the 2 treatments.

Exclusive Author Commentary
Yoshio Matsui, 08/16/09

The J-CORE study demonstrated that both the change in the pattern of arterial wave reflections and the decrease in arterial stiffness might contribute to a greater reduction in central SBP with the ARB/CCB treatment. Recently, the ACCOMPLISH study demonstrated that the combination of an ACE-I and a CCB was more effective than the combination of an ACE-I and a thiazide diuretic for decreasing cardiovascular events in high-risk hypertensive patients. Benefits were seen despite trivial differences in brachial SBP. Such a discrepancy between the difference of brachial SBP and clinical outcome was seen in the CAFÉ study and this was explained by the difference of central SBP. Because the central SBP and aortic PWV are independent predictors of cardiovascular morbidity in hypertensive patients, the benefits of the ACE-I/CCB combination in the ACCOMPLISH study may be attributable to a greater reduction in central SBP and arterial stiffness beyond the reduction in brachial SBP compared with that by the ACE-I/diuretic combination.

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