THE ACTION OF ANTIHYPERTENSIVES ON CENTRAL VESSEL STIFFNESS IN THE ELDERLY: A SUBSTUDY OF EVOUPIU (BRAZILIAN STUDY OF PULSE WAVE VELOCITY IN ELDERLY)

Abstract

Objective: Central arterial stiffness (CAS) is increased in the elderly, and its acceleration may be induced by systemic hypertension. The increased pulsatile pressure may promote damage to vital organs. Antihypertensive drugs can act on the CAS and decrease these patients’ cardiovascular risk. The present study aimed to compare the CAS of hypertensive elderly patients with different therapeutic schemes, using only two antihypertensive drugs: hydrochlorothiazide (HCTZ) as monotherapy or HCTZ associated with another class of antihypertensive drugs Design and method: This study is a cross-sectional analysis of elderly patients included in the data bank of EVOPIU. The data were extracted from the first medical consultation of the study. A total of 293 elderly hypertensive patients were separated into seven groups: those taking no antihypertensive medication (NAM, n = 47); hydrochlorothiazide alone (HCTZ, n = 25), HCTZ, and beta-blockers (n = 51); HCTZ and calcium channel blockers (n = 24); HCTZ and AII receptor blockers (n = 59); HCTZ and AII-converting enzyme inhibitors (n = 61); and HCTZ and spironolactone (HCTZ +SPIRO, n = 27). CAS was measured by femoral-carotid wave velocity (c-fPWV). Results: When compared to NAM patients, only the HCTZ + SPYRO group showed significantly lower values in c-fPWV (12.1 ± 0.44 vs. 10.5 ± 0.56 ms; P < 0.05, respectively), central pulse pressure (PP) augmentation index (Alx) (52.0 ± 1.9 vs. 45.6 ± 2.5 mmHg, P < 0.05), brachial PP (68.6 ± 2.1 vs. 61.5 ± 2.7 mmHg, P < 0.05). This group did not show higher serum potassium levels than the other groups studied. Conclusions: The results suggest that arterial stiffness in elderly patients may be, at least in part, caused by an effect of aldosterone on the arterial wall. CAS may be partially reversible with spironolactone. Its effect seems independent of observed effects on systemic arterial blood pressure.