title: Different patterns of peripheral versus central blood pressure in hypertensive patients treated with β-blockers either with or without vasodilator properties or with angiotensin receptor blockers.
abstract: BACKGROUND
  It is unclear whether the assumed inferiority of atenolol to reduce central (aortic) blood pressure (BP) extends to other β-blockers with vasodilating properties and, within that scope, how these drugs differ from the angiotensin receptor blockers (ARBs).
  
  
  METHODS
  In a retrospective study, we compared three groups of hypertensive patients (aged 35-65 years) chronically treated with either ARBs (n=83, group 1), carvedilol/nebivolol (n=75, 25+25 mg/day/5 mg/day, group 2) or atenolol (n=84, 50-100 mg/day, group 3), matched for age (mean 52 years), sex (61% female), brachial BP and concomitant use of diuretics (75-81%)and dihydropyridine calcium antagonists (27-33%). We measured aortic stiffness by pulse wave velocity (Complior), and central BP, central-peripheral pulse pressure amplification, wave reflection [augmentation index (AIx) corrected for heart rate] and augmentation pressure (Sphygmocor).
  
  
  RESULTS
  For similar age, sex distribution, brachial BP levels (145/85±11/10 mmHg) and pulse wave velocity (10±2 m/s), the atenolol group showed significantly (P<0.03 analysis of variance) higher central systolic BP (139±9 mmHg) versus group 2 (135±10 mmHg) and group 1 (132±11 mmHg), higher AIx (34±12%) versus group 2 (27±7%) and group 1 (23.0±9%), lower pulse pressure amplification (1.16±0.09) versus group 2 (1.22±0.10) and group 1 (1.31±0.11) and lower heart rate beats/min (61±9) versus group 2 (69±11) and group 1 (82±11). The differences on these values, between group 2 and group 1, were also significant (P<0.04). After adjustment for the heart rate, AIx became similar in groups 2 and 1, but still lower (P<0.04) than the atenolol group.
  
  
  CONCLUSIONS
  These findings suggest that, for similar brachial BP and aortic stiffness, treatment with either vasodilating β-blockers or angiotensin receptor blockers associates with lower central systolic BP and wave reflections than treatment with atenolol. These findings may suggest that the vasodilating β-blockers may exert more favourable central haemodynamic effects, compared with atenolol, which are more alike, although not completely equal, to those of the ARBs.
authors.affiliation: Faculdade de Medicina do Porto, Hospital Pedro Hispano, Matosinhos, Porto, Portugal. jjpolonia@gmail.com
authors.forename: Jorge
authors.initials: J
authors.lastname: Polónia
authors.forename: Loide
authors.initials: L
authors.lastname: Barbosa
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Silva
authors.forename: Susana
authors.initials: S
authors.lastname: Bertoquini
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001011:Aorta / Q000503:physiopathology; D001262:Atenolol / Q000627:therapeutic use; D001578:Benzopyrans / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects*; D001916:Brachial Artery; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D004095:Dihydropyridines / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004983:Ethanolamines / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D000068577:Nebivolol; D011412:Propanolamines / Q000627:therapeutic use; D011673:Pulsatile Flow / Q000187:drug effects; D012189:Retrospective Studies; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D001578:Benzopyrans; D002121:Calcium Channel Blockers; D002227:Carbazoles; D004095:Dihydropyridines; D004232:Diuretics; D004983:Ethanolamines; D011412:Propanolamines; D014665:Vasodilator Agents; D000068577:Nebivolol; D000077261:Carvedilol; D001262:Atenolol