A Randomized Controlled Study on the Effects of Bisoprolol and Atenolol on Sympathetic Nervous Activity and Central Aortic Pressure in Patients with Essential Hypertension

Abstract

Objectiveβ-blockers (BBs) with different pharmacological properties may have heterogeneous effects on sympathetic nervous activity (SNA) and central aortic pressure (CAP), which are independent cardiovascular factors for hypertension. Hence, we analyzed the effects of bisoprolol and atenolol on SNA and CAP in hypertensive patients.MethodsThis was a prospective, randomized, controlled study in 109 never-treated hypertensive subjects randomized to bisoprolol (5 mg) or atenolol (50 mg) for 4–8 weeks. SNA, baroreflex sensitivity (BRS) and heart rate (HR) variability (HRV) were measured using power spectral analysis using a Finometer. CAP and related parameters were determined using the SphygmoCor device (pulse wave analysis).ResultsBoth drugs were similarly effective in reducing brachial BP. However, central systolic BP (−14±10 mm Hg vs −6±9 mm Hg; P<0.001) and aortic pulse pressure (−3±10 mm Hg vs +3±8 mm Hg; P<0.001) decreased more significantly with bisoprolol than with atenolol. The augmentation index at a HR of 75 bpm (AIxatHR75) was significantly decreased (29%±11% to 25%±12%; P = 0.026) in the bisoprolol group only. Furthermore, the change in BRS in the bisoprolol group (3.99±4.19 ms/mmHg) was higher than in the atenolol group (2.66±3.78 ms/mmHg), although not statistically significant (P>0.05). BRS was stable when RHR was controlled (RHR≤65 bpm), and the two treatments had similar effects on the low frequency/high frequency (HF) ratio and on HF.ConclusionBBs seem to have different effects on arterial distensibility and compliance in hypertensive subjects. Compared with atenolol, bisoprolol may have a better effect on CAP.Trial RegistrationClinicalTrials.gov NCT01762436

Effects of β-Blockers With and Without Vasodilating Properties on Central Blood Pressure

“…55 Other antihypertensive drug classes were concomitantly administered in 5 studies (amlodipine, 51 hydrochlorothiazide, 23,53 lisinopril, 46 and lisinopril or losartan 22 ), whereas an add-on treatment approach with prespecified or unspecified other antihypertensive drug classes was allowed in 7 cases. 18,19,24,46,[52][53][54] In 9 studies, 18,20,23,47,48,[54][55][56] 19,21,22,24,50,51,53 ; and 1 study 26 did not report information about blindness of treatment.…”

Combination Antihypertension Therapy: The “Underresearched” Combinations

“…Несмотря на то, что эффект является классовым, существуют данные исследований о различиях между отдельными ББ. Так, в рандомизированном исследо-вании у 109 пациентов с ранее не леченной АГ бисо-пролол был более эффективен, чем атенолол в отно-шении снижения центрального аортального систоли-ческого АД и индекса аугментации, нормированного на ЧСС 75 уд./мин [38].…”

New Insight into Effects of β-Blockers on Arterial Functions

“…The higher the PR, the more the artery stiffens, especially in hypertensive patients [8]. Zhou et al [9] have shown that arterial distensibility and compliance were significantly more improved by bisoprolol therapy than by atenolol therapy, and these effects were independent of any PR-lowering effects. Therefore, the PWV-lowering effect of bisoprolol could be due to its potent PR-lowering effect and to vasodilation caused by β2 stimulation benefiting arterial elasticity.…”

“…Propranolol and atenolol were not effective in lowering wave reflection, but metoprolol led to a possible improvement, and labetalol, carvedilol, and nebivolol can reduce wave reflection [7]. Zhou et al [9] showed that bisoprolol had a better effect on central aortic pressure compared to atenolol.…”