Hypertension affects one third of the world’s population and is
a major preventable risk factor for premature death and disability
[1, 2]. Isolated systolic hypertension (ISH), defined by
the European Society of Hypertension (ESH) guidelines as
diastolic blood pressure (DBP) 140 mmHg, is the most common type of
hypertension from middle age onwards [3].
Since the 1980s, a number of large epidemiological studies
have confirmed the importance of raised pulse pressure (PP)
as a strong independent predictor of cardiovascular events and
mortality, if less consistently than systolic BP [4–16]. One
probable reason for the lesser consistency is the effect of
age. In the US NHANES III survey, 75 % of people with
hypertension were aged over 50 years and 80 % of these had
ISH, demonstrating that widened PP is highly prevalent in an
aging population with hypertension.
Vasodilators and beta-blockers are amongst the most widely
used pharmacological treatment for hypertension and heart failure.
In hypertension, vasodilators have been shown to improve
cardiovascular outcome due to their BP lowering effects, although
specific class effects beyond BP lowering could also
be implicated [18]. Beta-blockers, selective or not, may be less
effective [19, 20]. Most vasodilators and vasodilating betablockers
reduce total peripheral resistance (TPR) remarkably
effectively as demonstrated by their efficacy on lowering the
steady components of blood pressure (i.e. DBP and mean arterial
pressure (MAP)) [21–25]. MAP and DBP have a much
closer relationship to TPR than the pulsatile components of