title: Hemodynamic and central blood pressure differences between carvedilol and valsartan added to lisinopril at rest and during exercise stress.
abstract: There is little information about the hemodynamic and exercise-response implications of renin-angiotensin system blocker combinations. After a 3-week lisinopril (L; 40 mg/day) run-in, carvedilol (C; 20 then 40 mg/day) or valsartan (V; 160 then 320 mg/day) was added to L for 4 weeks each in a forced-titration, random order-entry crossover study in 30 subjects. Arterial tonometry (central pressures and time-tension index, TTI); impedance cardiography (steady-state hemodynamics), and ultrasound (carotid flow) were performed at rest and during supine bicycle exercise at 30 and 60 watts. At rest, both V and C lowered TTI similarly (7% to 9%, P = .05 compared with L, in part because they lowered blood pressure (3 to 7/3 to 4 mm Hg). V lowered central systolic pressure, augmentation pressure (AP), and systemic vascular resistance (SVR, all P < .02); C lowered heart rate but not central systolic pressure or SVR. During exercise, V persistently lowered central systolic pressure, AP, and SVR, whereas C did not. Neither drug affected exercise responses or carotid blood flow. Adding V or C to an angiotensin-converting enzyme inhibitor reduced cardiac workload by different mechanisms: vasodilation and reduced central blood pressure with V and lower heart rate with C.
authors.affiliation: Department of Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY 14215, USA. jizzo@buffalo.edu
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Izzo
authors.forename: Minesh
authors.initials: M
authors.lastname: Rajpal
authors.forename: Shaila
authors.initials: S
authors.lastname: Karan
authors.forename: Sirisha
authors.initials: S
authors.lastname: Srikakarlapudi
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Osmond
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002227:Carbazoles / Q000008:administration & dosage*; D002307:Cardiography, Impedance; D000077261:Carvedilol; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D015444:Exercise / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D017706:Lisinopril / Q000008:administration & dosage*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D012146:Rest / Q000502:physiology; D013777:Tetrazoles / Q000008:administration & dosage*; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000068756:Valsartan
chemical_list: D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D013777:Tetrazoles; D000077261:Carvedilol; D000068756:Valsartan; D017706:Lisinopril; D014633:Valine