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.
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.
Polónia
Jorge
J
Faculdade de Medicina do Porto, Hospital Pedro Hispano, Matosinhos, Porto, Portugal. jjpolonia@gmail.com
Barbosa
Loide
L
Silva
José Alberto
JA
Bertoquini
Susana
S
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*
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