Pulse Pressure Is Useful for Determining the Choice of Antihypertensive Drugs in Postmenopausal Women

OBJECTIVE: To assess the efficacy of various classes of antihypertensive drugs in postmenopausal women with hypertension using pulse pressure (PP) as an index. PATIENTS AND METHODS: Selected women were required to be naturally menopausal for at least 1 year but not more than 5 years past their menstrual period. Exclusion criteria were a history of preeclampsia or eclampsia, a severe illness such as myocardial infarction or stroke within 6 months, the use of estrogens or progestins within 3 months, proteinuric nephropathy, and surgically induced menopause. There were 114 women who participated in this study after having given informed consent. These women were diagnosed as having hypertension based on an office blood pressure >140/90 mm Hg as well as a self-measured blood pressure at home >130/85 mm Hg. If both levels of blood pressure were not fulfilled, the patients were excluded. All antihypertensive medications were withdrawn 6 weeks before the initiation of the study. The patients were randomly assigned in equal numbers to the following groups: (1) combination therapy with losartan (angiotensin receptor blocker) 50 mg daily + trichlormethiazide (diuretic) 2 mg twice a week, and (2) combination therapy with cilnidipine (calcium channel blocker) 5 mg + arotinolol (αβ-blocker) 10 mg daily. RESULTS: The patients were retrospectively divided into three groups according to their PP at the start of the study: Group I (n = 24), >65 mm Hg; Group II (n = 58), 65-45 mm Hg, and Group III (n = 32), <45 mm Hg. In Group I, combination therapy with cilnidipine + arotinolol resulted in a greater reduction in the systolic blood pressure than the combination therapy with losartan + trichlormethiazide (from 169/88 ± 2/5 to 133/73 ± 2/5 mm Hg vs. from 169/88 ± 2/5 to 149/66 ± 2/5 mm Hg, p < 0.05). On the other hand, in Group III, losartan + trichlormethiazide decreased diastolic as well as systolic blood pressures (from 152/106 ± 2/2 to 123/78 ± 1/1 mm Hg vs. from 149/107 ± 2/2 to 129/84 ± 2/1 mm Hg, p < 0.05). In Group II, there were no differences between the two antihypertensive regimens. Laboratory findings were not influenced by any type of treatment. CONCLUSIONS: PP measurement before starting medication for hypertension may be useful for determining the choice of antihypertensive drugs.