Discordant beta-blocker effects on clinic, ambulatory, resting, and exercise hemodynamics in patients with hypertension.
OBJECTIVE
To determine the correlation between ambulatory and clinic blood pressure in assessing antihypertensive response to beta-blockade, to test whether blood pressure response to metoprolol is associated with the heart rate response, and to determine whether exercise and resting heart rate responses to metoprolol are correlated.


METHODS
Post hoc analysis of a prospective cohort study.


METHODS
University-affiliated general clinical research center.


METHODS
Fifty-one patients aged 35-65 years with uncomplicated hypertension. Intervention. All patients received metoprolol at a dosage titrated to achieve a diastolic blood pressure below 90 mm Hg.


RESULTS
Clinic and 24-hour ambulatory blood pressure measurements were obtained and exercise treadmill testing was performed before and after metoprolol treatment. Based on ambulatory blood pressure data, 24 patients (47%) responded (defined as at least a 10% reduction in diastolic blood pressure) to metoprolol compared with 36 patients (71%) based on clinic blood pressure data (p=0.027). Clinic blood pressure was associated with a 67% false-positive rate (responsive blood pressure by clinic data that was actually nonresponsive by ambulatory data). Blood pressure responders and nonresponders exhibited similar reductions in exercise heart rate (24% and 23%, p=0.74). However, responses to metoprolol measured by exercise heart rate versus resting heart rate were not significantly correlated (r=0.24, p=0.105).


CONCLUSIONS
Reliance on clinic blood pressure or resting heart rate for making beta-blocker treatment decisions may yield less than optimal assessment of the antihypertensive response or degree of beta-blockade.
Beitelshees
Amber L
AL
Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, Florida 32610-0486, USA.
Zineh
Issam
I
Yarandi
Hossein N
HN
Pauly
Daniel F
DF
Johnson
Julie A
JA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D015444:Exercise / Q000502:physiology; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D008790:Metoprolol