Can Extended-Release Isosorbide Mononitrate be Used as Adjunctive Therapy for Systolic Hypertension? An Open Study Employing Pulse-Wave Analysis to Determine Effects of Antihypertensive Therapy.

Augmentation of the systolic ejection pressure wave by an exaggerated reflectance wave, demonstrable by applanation tonometry of the radial artery, is an important contribution to systolic hypertension of the elderly. Therefore, a study of extended-release isosorbide mononitrate, which may reduce the augmentation, was performed in a group of patients aged 49 to 80 years with systolic hypertension. This agent was added, in a dose of 30 to 120 mg once daily, to existing antihypertensive medications and the response of the arterial pulse wave pattern was observed after 7 to 34 weeks of continuing treatment. There were decreases in brachial systolic blood pressure, indirectly measured aortic systolic blood pressure, and pulse wave augmentation. These findings indicate the need for controlled studies of nitrate therapy as an adjunct to treatment with conventional antihypertensive drugs in systolic hypertension of the elderly. The studies should include analysis of pulse waveform to complement conventional sphygmomanometry.