C-reactive protein elevation predicts pulse pressure reduction in hypertensive subjects

Cross-sectional studies have shown a positive association between increased pulse pressure ( PP) and an increased likelihood of a C-reactive protein (CRP) level > 3 mg/L. In a retrospective subgroup analysis of the hypertensive subjects of the multicenter double-blind study, REASON (PREterax in Regression of Arterial Stiffness in a ContrOlled Double-BliNd), in which fixed first-line antihypertensive combination therapy with an angiotensin converting enzyme ( ACE) inhibitor, perindopril ( 2 mg), and a diuretic, indapamide (0.625 mg), proved significantly more effective than atenolol in normalizing PP, we sought to determine whether perindopril plus indapamide was also more effective than atenolol in lowering CRP levels and, if so, whether this effect correlated with a preferential reduction in PP. At the final visit ( 12 months) in the 269 patients studied, the decrease in PP was greater, and the proportion of patients with CRP > 3 mg/L lower (17.9% versus 28. 9%, P = 0.03; adjusted odds ratio, 1.02 to 4.08, P = 0.01), in the perindopril plus indapamide group than in the atenolol group. After adjustment for confounders, patients with a baseline CRP > 3 mg/L displaying the greatest decrease in PP were more likely ( P = 0.04) to have a CRP <= 3 mg/L at 12 months. No such relationship was found with systolic or diastolic blood pressure. Perindopril - indapamide combination therapy is more effective than beta-blockade in lowering elevated CRP in hypertensive subjects. This effect is significantly associated with a more effective PP reduction in patients with baseline CRP > 3 mg/L.