Korean Circ J.  2007 Aug;37(8):359-364. 10.4070/kcj.2007.37.8.359.

The Effect of Isosorbide Dinitrate Intravenous Injection on the Hemodynamics and Arterial Stiffness of Patients with Isolated Systolic Hypertension

• Lee SJ
• Park CG
• Lee SW
• Shin WY
• Jin DG
• Seo HS
• Oh DJ

• KMID: 2029063
• DOI: http://doi.org/10.4070/kcj.2007.37.8.359

Abstract

BACKGROUND AND OBJECTIVES: In clinical practice, isolated systolic hypertension (ISH) is common for elderly patients and it is correlated with cardiovascular mortality. However, it is difficult to control the systolic blood pressure (BP) with using the currently available antihypertensive drugs without influencing the diastolic BP. The purpose of this study is to evaluate the effect of isosorbide dinitrate on the central BP and arterial stiffness by performing invasive testing.
SUBJECTS AND METHODS
Thirty subjects who had ISH and who underwent coronary angiography were enrolled in this study. The invasively measured central blood pressure, pulse pressure and pulse wave velocity were obtained after isosorbide dinitrate was injected intravenously and these values were analyzed in relation to age, gender, the body mass index, diabetes mellitus, dyslipidemia, smoking and the current dosing with antihypertensive drugs.
RESULTS
One minute after intravenous injection of isosorbide dinitrate, the central systolic BP was significantly decreased compare to the baseline value (142.23+/-12.32 mmHg vs 164.97+/-14.43 mmHg, respectively, p<0.001), and this change was sustained for 5 minutes (141.05+/-14.84 mmHg vs 164.97+/-14.43 mmHg, respectively, p<0.001). The mean values, during the 5 minute period, of the pulse pressure (65.99+/-13.63 mmHg vs 87.30+/-13.71 mmHg, respectively, p<0.001) and the pulse wave velocity (11.22+/-3.20 m/sec vs 12.91+/-4.11 m/sec, respectively, p<0.001) also revealed significant changes. Yet there was no significant decrease of the diastolic BP. Analysis of subgroups that were classified by gender, age, BMI, diabetes mellitus, dyslipidemia, smoking, the degree of the systolic BP and PWV, and taking antihypertensive drugs showed a similar pattern.
CONCLUSION
Isosorbide dinitrate was very effective for selective control of the systolic BP in ISH patients. It is also expected to prevent cardiovascular complications by improving arterial stiffness.

Keyword

Hypertension; Systolic pressure; Isosorbide dinitrate

MeSH Terms

Aged
Antihypertensive Agents
Blood Pressure
Body Mass Index
Coronary Angiography
Diabetes Mellitus
Dyslipidemias
Hemodynamics*
Humans
Hypertension*
Injections, Intravenous*
Isosorbide Dinitrate*
Isosorbide*
Mortality
Pulse Wave Analysis
Smoke
Smoking
Vascular Stiffness*
Antihypertensive Agents
Isosorbide
Isosorbide Dinitrate
Smoke

Figure

• 

  Fig. 1 A 5 Fr. Judkins catheter was placed just distal to the origin of the left subclavian artery. A: to calculate the distance between the pulse waves of the aorta and right iliac artery. B: the length of the sheath (12 cm) and the catheter exposed to outside of the sheath was subtracted from the total length of the catheter (100 cm).

• 

  Fig. 2 The change of parameters after the injection of isosorbide dinitrate. The decrease of the systolic pressure (A), pulse pressure (D) and pulse wave velocity (E) were significant just 1 minute after injection and the mean value for 5 minutes was also significantly lower compare to the baseline level. However, the diastolic blood pressure was not change (B). The heart rate was increased at 1 minute and mean from the baseline (C). SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart pressure, PWV: pulse wave velocity.

• 

  Fig. 3 The systolic blood pressure (A) and pulse wave velocity (B) in patients taking antihypertensive drugs were significantly decreased at 1 minute and the mean from the baseline. SBP: systolic blood pressure, PWV: pulse wave velocity.

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