Improved baroreflex sensitivity in elderly hypertensives on lisinopril is not explained by blood pressure reduction alone. J Hypertens 1993 Oct;11(10):1113-20
Date
10/01/1993Pubmed ID
8258676DOI
10.1097/00004872-199310000-00016Scopus ID
2-s2.0-0027377011 (requires institutional sign-in at Scopus site) 30 CitationsAbstract
OBJECTIVE: The major goals of this study were to determine whether lisinopril and nifedipine lowered blood pressure and improved carotid baroreflexes in older hypertensives.
DESIGN: The effects of lisinopril at 10-40 mg/day versus nifedipine gastrointestinal therapeutic system (GITS) at 30-90 mg/day on blood pressure and baroreflex sensitivity were studied after 3 weeks each on (1) single-blind placebo, (2) double-blind assignment to either lisinopril or nifedipine, (3) single-blind placebo, and (4) crossover to double-blind lisinopril or nifedipine. Measurements at the end of the four phases included 24-h blood pressure using the Accutracker, laboratory hemodynamics with the Dinamap and impedance cardiography, baroreflex sensitivity with the pneumatic neck chamber, and plasma samples for neurohumoral and metabolic activity.
PATIENTS: Thirteen patients aged 55 years or older (mean +/- SEM 65 +/- 1 years) with mild-to-moderate hypertension completed the study.
MAIN OUTCOME MEASURES: The primary data for analysis across the four study phases included ambulatory blood pressure values, laboratory hemodynamics, and baroreflex sensitivity.
RESULTS: Compared with the preceding placebo, lisinopril and nifedipine lowered 24-h blood pressure significantly. In the laboratory, the effects of both compounds on blood pressure, cardiac output, calculated total systemic resistance, and the stroke volume-pulse pressure relationship, an index of arterial compliance, were similar. Lisinopril was associated with a relative increase in the standing systolic blood pressure compared with nifedipine (P < 0.05). This coincided with an enhanced heart-rate (R-R interval) response to neck pressure, which also decreased carotid transmural pressure, with lisinopril versus nifedipine (P < 0.05).
CONCLUSIONS: Lisinopril and nifedipine were both effective as monotherapy for controlling blood pressure in these elderly patients. Despite similar effects on blood pressure and systemic hemodynamics, baroreflex sensitivity in response to a reduction in carotid transmural pressure was greater with lisinopril than with nifedipine.
Author List
Egan BM, Fleissner MJ, Stepniakowski K, Neahring JM, Sagar KB, Ebert TJAuthor
Thomas J. Ebert MD, PhD Adjunct Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAmbulatory Care
Baroreflex
Blood Pressure
Blood Pressure Determination
Double-Blind Method
Female
Humans
Hypertension
Lisinopril
Male
Middle Aged
Nifedipine
Placebos