Background: Central blood pressure (BP) is considered a better predictor of cardiovascular events than brachial BP, and mechanisms influencing central BP are mostly related to reduction of arterial stiffness and/or reflected waves. Comparison between drugs on their effect in central hemodynamics has poorly been studied.

Objective: To assess the role of 3 antihypertensive drugs on central BP, in comparison with placebo, and their associated mechanisms.

Methods: Multicenter, multinational, randomized, double blind, placebo-controlled clinical trial analyzing the effects of a 12-week treatment with amlodipine, candesartan, indapamide sustained release, or placebo in 145 outpatients with essential hypertension and no cardiovascular complications, enrolled in the X-CELLENT (NatriliX SR versus CandEsartan and amLodipine in the reduction of systoLic blood prEssure in hyperteNsive patienTs) study. Post-hoc analysis focusing on central hemodynamics.

Results: Each active drug reduced brachial and mostly central BP. Amlodipine and indapamide produced a greater reduction of central than brachial pulse pressures, while candesartan had a similar but lesser effect. Augmented pressure, a well established wave reflection index, was reduced by all active drugs. Within duration of the trial, no effect was achieved on pulse wave velocity. Pulse pressure amplification was similarly increased by all active treatments.

Conclusions: Amlodipine and indapamide, more than candesartan, have an effect on both static and pulsatile central BP, causing a reduction of central systolic, diastolic and pulse pressures. Within the limits of the investigation, central BP reduction was not due to changes in arterial stiffness, but rather in wave reflections and pulse pressure amplification.