CNS EFFECTS OF ANTIHYPERTENSIVE THERAPIES

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The proposed research will broaden and intensify our current investigation of physiological and neuropsychological sequellae of antihypertensive therapies. Using the laboratory-based, quantitative assessment methodology developed in our initial study with normotensive males, two additional studies are proposed to evaluate nonpharmacological and pharmacological treatment effects in male and female hypertensives. Of particular interest are the effects of well tolerated antihypertensive agents, such as ACE inhibitors and hydrophilic beta blockers on measures of sleep physiology, cognitive and perceptual-motor function, and mood state. These effects are to be related, where possible, to changes in cardiovascular, circulatory, and metabolic function. We are als proposing to conduct the first studies of this type in post-menopausal female patients. Finally, both the studies proposed will include intensive comparisons of pharmacological therapy with the highly successful nonpharmacological treatment program developed in our current research. Study I will consist of a randomized, placebo-controlled evaluation of treatment effects in 64 male hypertensive patients assigned to one of several pharmacological conditions (enalapril, atenolol, placebo) or nonpharmacological treatment. Selected CNS parameters, including sleep, cardiovascular, and metabolic functions will be assessed before and after each treatment phase. Study II is the first prospective, placebo- controlled evaluation of biobehavioral sequellae of treatment in female patients. Specifically, 64 post-menopausal female hypertensives will be randomly assigned to propranolol, enalapril, placebo or nonpharmacological therapy. Current assessment procedures will be modified accordingly for this study. Taken together, these studies will provide an in-depth evaluation of biobehavioral sequellae of current antihypertensive therapies, and will be of value in the clinical management of cardiovascular disease.