The relationship of multiple antihypertensive therapies to arterial stiffness assessed by brachial-ankle pulse wave velocity

Most patients require as many as three antihypertensive agents to achieve BP control. The number of antihypertensive drugs often correlates with arterial stiffness. Arterial stiffness is increasingly recognized as an important prognostic index and potential therapeutic target in hypertensive patients and measured by brachial-ankle pulse wave velocity (baPWV). This study included 1686 patients >18 years old referred or self-referred to the outpatient hypertensive unit at a single cardiovascular center. Individuals were separated into normotensive, monotherapy, two-combination, and three-and-more prescription groups for measuring home blood pressure, blood lab components, and baPWV. Treatment started with a single drug, adding another drug before achieving maximum recommended initial dose. If goal BP (mean BP < 135/85 mm Hg at home) was not achieved with two drugs, a third drug was selected. The three-and-more prescriptions group had lower high-density lipoprotein-cholesterol, higher triglycerides, larger left ventricle diastolic diameter, left ventricle systolic diameter, left atrium and LV mass index than other groups. Only baPWV significantly correlated with multiple antihypertensive drug use. The lack of this association in easily controlled hypertension, suggests a possible role of arterial stiffness in the control of optimal blood pressure. In the context of accelerated arterial aging (stiffness), multiple antihypertensive drugs are necessary to achieve BP control.