-Blockers Reduce Aortic Stiffness in Hypertension but Nebivolol, Not Atenolol, Reduces Wave Reflection

Mahmud, Azra; Feely, J.

doi:10.1038/ajh.2008.156

Cited by 124 publications

(110 citation statements)

References 15 publications

(21 reference statements)

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“…In the present study, while atenolol reduced brachial BP effectively as assessed by brachial sphygmomanometry, it does not reduce augmentation pressure or index, a finding that has been observed in other studies. 3,20 In fact, augmentation pressure and augmentation index were increased with atenolol monotherapy in this study (Table II). Recent data from the Conduit Artery Function Evaluation (CAFE) have spotlighted the potential importance of these two parameters in reducing coronary events.…”

Section: Discussionsupporting

confidence: 51%

Carvedilol Reduces Aortic Wave Reflection and Improves Left Ventricular/Vascular Coupling: A Comparison With Atenolol (CENTRAL Study)

Shah¹,

Smith

Nichols

et al. 2011

The Journal of Clinical Hypertension

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Blood pressure (BP) characteristics, such as central aortic pressure and arterial stiffness, independently predict cardiovascular events. The effects of pharmacologically dissimilar b-blockers on these properties have not been fully elucidated. Patients with essential hypertension and without significant concomitant cardiovascular disease were randomly assigned to controlled-release carvedilol, forcetitrated to 80 mg (n=22), or atenolol, force-titrated to 100 mg (n=19); each was given once daily for 4 weeks. Baseline characteristics were similar. At the end of week 4, atenolol and carvedilol reduced central and brachial systolic and diastolic BP to a similar extent. Central augmentation index was increased in atenolol-treated patients but not carvedilol-treated patients (atenolol 4.47% vs carvedilol )0.68%; P=.04). Mean augmented central aortic pressure increased slightly during atenolol treatment (+1.1 mm Hg) but decreased slightly during carvedilol treatment ()1.1 mm Hg), although the difference in these changes was not statistically significant (P=.23). Pulse pressure amplification was reduced more with atenolol at week 4 (atenolol )10.7% vs carvedilol )1.8%; P=.02). Therefore, we conclude that carvedilol results in more favorable pulse pressure amplification and augmentation index by increasing arterial compliance and reducing the magnitude of wave reflection, respectively, compared with atenolol. J Clin Hypertens (Greenwich). 2011;13:917-924. Ó2011 Wiley Periodicals, Inc.For many years, b-blockers were advocated as first-line therapy for most patients with hypertension. This class flourished during the past 50 years as the mainstay for the prevention and treatment of various cardiovascular disorders such as cardiac arrhythmias, myocardial infarction, and hypertension. Recently, the role of bblockers in uncomplicated hypertension has been questioned. Indeed, several recently updated guidelines have deemphasized their place in therapy.2,3 The reasons for this evolution are multifactorial, including publication of several clinical trials and meta-analyses which concluded that b-blockers are less effective than contemporary antihypertensives. [4][5][6][7] These observations could be ascribed to multiple factors including the fact that b-blockers exhibit an adverse metabolic profile, are poorly tolerated relative to newer antihypertensives, and have mismatched mechanisms of action with the pathophysiology of hypertension in elderly hypertensive patients. [8][9][10][11] Multiple recent studies suggest that blood pressure (BP) characteristics beyond the brachial cuff, such as central aortic pressure, wave reflection, and arterial stiffness, independently predict cardiovascular events, including all-cause and cardiovascular mortality, fatal and nonfatal coronary events, and fatal strokes in uncomplicated essential hypertension.12-15 These characteristics cannot be appreciated with conventional clinic BP measurements at the brachial artery. Radial artery tonometry and synthesis of the central aortic pressure wavefor...

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Section: Discussionsupporting

confidence: 51%

Carvedilol Reduces Aortic Wave Reflection and Improves Left Ventricular/Vascular Coupling: A Comparison With Atenolol (CENTRAL Study)

Shah¹,

Smith

Nichols

et al. 2011

The Journal of Clinical Hypertension

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“…Although AIx and HR are inversely related, a small decrease in HR (8 beats per min) occurs with a decrease in AIx after vasodilating drug therapy. 31 The observed 5 beats per min decrease following WBV training did not influence the changes in AIx and AIx@75. Thus, it is likely that repetition of the acute vascular effects during 6 weeks would be responsible for the improvements in baPWV and AIx after WBV training.…”

Section: Discussionmentioning

confidence: 79%

Whole-body vibration training reduces arterial stiffness, blood pressure and sympathovagal balance in young overweight/obese women

et al. 2012

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Obesity is associated with early cardiovascular dysfunction and reduced muscle strength. Whole-body vibration (WBV) training may improve arterial function and muscle strength. The effects of WBV training on arterial stiffness (brachial-ankle pulse wave velocity, baPWV), wave reflection (augmentation index, AIx), brachial systolic blood pressure (bSBP), aortic systolic blood pressure (aSBP), heart rate variability, and muscle strength (one-repetition maximum, 1RM) were examined in 10 young (21 ± 2 year) overweight/obese women (body mass index, BMI¼29.9 ± 0.8 kg m -2 ). Participants were randomized to a 6-week WBV training or non-exercising control (CON) period in a crossover design. WBV training (3 daysÂweek) consisted of static and dynamic squats and calf raises with vibration intensity at 25-30 Hz and 1-2 mm amplitude (2.83-4.86 G). There were significant (Po0.05) decreases in baPWV (À0.9±0.3 m s -1 ), AIx (À8.0±2.2 %), bSBP (À5.3±1.5 mm Hg), aSBP (À5.2 ± 2.1 mm Hg), low-frequency power (À0.13 ± 0.05 nu) and sympathovagal balance (LF/HF, À0.42 ± 0.16) after WBV training compared with CON. Significant (Po0.05) increases in high-frequency power (HF, 0.19 ± 0.04 nu) and leg extension 1RM (8.2±2.3 kg) occurred after WBV training compared with CON. Six weeks of WBV training decreased systemic arterial stiffness and aSBP via improvements in wave reflection and sympathovagal balance in young overweight/obese normotensive women. WBV training may benefit arterial function and muscle strength in deconditioned individuals who cannot perform conventional exercise.

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“…Two short-term studies (4 to 5 weeks) reported that NEB had a significantly greater effect on central pulse pressure compared with the cardioselective BB atenolol. 8, 13 Dhakam et al 8 in their study demonstrated that overall aortic pulse pressure was 4 mm Hg lower after NEB therapy than after atenolol therapy. 8 Moreover, the results from the Conduit Artery Function Evaluation Study 6 indicate that even a 3-mm Hg reduction in central pulse pressure was associated with better cardiovascular outcome.…”

Section: Bb and Reduction In Central Aortic Pressurementioning

confidence: 96%

“…Previous studies have demonstrated a significant reduction in PWV after treatment with NEB. 8,13 It has been suggested that the effect of BB on PWV may be related to the concomitant effect of reduction in mean arterial pressure, sympathetic tone, and HR. Consequently, one possible explanation for the nonsignificant change in PWV in the present study is also the significantly smaller reduction in HR during the 1-year treatment period (Ϸ6 bpm).…”

Section: Bb and Reduction In Central Aortic Pressurementioning

confidence: 99%

Differential Effects of Nebivolol and Metoprolol on Central Aortic Pressure and Left Ventricular Wall Thickness

et al. 2011

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Abstract-The aim of this study was to investigate the effects of the vasodilating ␤-blocker nebivolol and the cardioselective ␤-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (rϭ0.41; Pϭ0.001) and with central pulse pressure change (rϭ0.32; Pϭ0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-ofprinciple study provides evidence to suggest that ␤-blockers with vasodilating properties may offer advantages over conventional ␤-blockers in antihypertensive therapy; however, this remains to be tested in a larger trial. lood pressure (BP) varies throughout the arterial tree because of pulse wave amplification, a phenomenon of wave reflection and arterial stiffness. 1 Because of pulse wave amplification, reduction in brachial BP does not reflect changes in central BP, which may become a more important target in the treatment of hypertension. Recent data from the Strong Heart Study 2 confirm earlier results from smaller studies on high-risk patients 3,4 that central pulse pressure is superior to brachial pulse pressure in the prediction of further cardiovascular events. Moreover, several studies have demonstrated that brachial BP is not a good surrogate for the hemodynamic effects of drug therapies on central circulation. The recently published EX-PLOR Study 5 and the Conduit Artery Function Evaluation Study 6 clearly demonstrated that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers have a more pronounced effect on reducing central BP compared with the cardioselective ␤-blocker (BB) atenolol. Different effects of BB on central BP can explain the findings of a recent meta-analysis published by Law et al, 7 which demonstrates a slight inferiority of BB in preventing stroke. The detrimental effect of BB on central BP has generated criticism regarding its use as first line therapy for essential hypertension. Dhakam et al 8 questioned the hypothesis that the inferiority of atenolol in reducing central BP is a class effect of BB. They demonstrated that the novel vasodilating BB nebivolol (NEB) reduces central BP si...

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-Blockers Reduce Aortic Stiffness in Hypertension but Nebivolol, Not Atenolol, Reduces Wave Reflection

Cited by 124 publications

References 15 publications

Carvedilol Reduces Aortic Wave Reflection and Improves Left Ventricular/Vascular Coupling: A Comparison With Atenolol (CENTRAL Study)

Carvedilol Reduces Aortic Wave Reflection and Improves Left Ventricular/Vascular Coupling: A Comparison With Atenolol (CENTRAL Study)

Whole-body vibration training reduces arterial stiffness, blood pressure and sympathovagal balance in young overweight/obese women

Differential Effects of Nebivolol and Metoprolol on Central Aortic Pressure and Left Ventricular Wall Thickness

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