Objectives: Essential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients.

Methods: In this double-blind placebo-controlled crossover study we randomised 53 treatment-naïve hypertensive patients to receive doxazosin 4 mg, candesartan 16 mg, bisoprolol 5 mg, isosorbide mononitrate (ISMN) 50 mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug.

Results: Baseline AIx and PPA determined brachial and central BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7–28.9%) and high PPA (1.22–1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3–48.2%) and low PPA (1.05–1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. There were no significant differences in BP reduction between the baseline extremes of SV, CO, PVR or aPWV with any drug.

Conclusion: Our study suggests that haemodynamic profiling by AIx or PPA could serve as a valuable tool in management of hypertension, particularly if beta-blockers are considered for treatment. Among the drug classes and doses used, the angiotensin II receptor antagonist reduced BP the most regardless of the underlying haemodynamic profile.