title: Destiffening effect of valsartan and atenolol: influence of heart rate and blood pressure.
abstract: OBJECTIVE
  We investigated data in 373 patients from the EXPLOR trial to determine the influence of heart rate (HR) and blood pressure (BP) on aortic stiffness in response to beta-blockade or angiotensin 2 type 1 receptor antagonism, administered during 24 weeks.
  
  
  METHODS
  Carotid-femoral pulse wave velocity (PWV) was measured with aplanation tonometry (Sphygmocor ) after 8 (W8) and 24 weeks (W24) of treatment by the single-pill combination valsartan-amlodipine (80/5  mg, then 160/10  mg) or an atenolol-amlodipine combination (50/5  mg, then 100/10  mg) in a prospective, randomized, parallel-groups multicenter trial with PROBE design. Drugs were up-titrated at W8. We analyzed the changes in PWV in relation with the changes in BP and HR, and major covariates, using mixed models in each treatment arm.
  
  
  RESULTS
  The unadjusted reductions in mean BP and PWV were not significantly different between groups. HR was significantly reduced in the atenolol group, but not in the valsartan group. After adjustment on BP and HR, PWV significantly decreased with valsartan [-0.37  m/s (-0.70 to -0.08) at W8 and -0.43 (-0.76 to -0.10) m/s at W24], whereas no significant change was observed after atenolol [-0.16  m/s (-0.49 to 0.17) at W8 and -0.05 (-0.35 to 0.44) m/s at W24].
  
  
  CONCLUSIONS
  These findings suggest that the reduction in PWV observed after atenolol could be explained by changes in BP and HR, whereas in patients treated by valsartan, about half of the decrease in aortic stiffness was BP-independent.
authors.affiliation: aUniversité Paris Descartes, Sorbonne Paris Cité bINSERM, U970 cAssistance Publique Hôpitaux de Paris, HEGP, dgroupe hospitalier St Joseph, Paris eNovartis Pharma, Rueil Malmaison, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.forename: Hélène
authors.initials: H
authors.lastname: Beaussier
authors.forename: Assya
authors.initials: A
authors.lastname: Achouba
authors.forename: Stéphane
authors.initials: S
authors.lastname: Laurent
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001262:Atenolol / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D013777:Tetrazoles / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000068756:Valsartan; D059289:Vascular Stiffness / Q000187:drug effects*
chemical_list: D000959:Antihypertensive Agents; D013777:Tetrazoles; D001262:Atenolol; D000068756:Valsartan; D014633:Valine