Effect of Atenolol vs Metoprolol Succinate on Vascular Function in Patients With Hypertension

Abstract

Background:We evaluated the effect of atenolol vs metoprolol succinate on vascular function in patients with essential hypertension. Hypothesis: Given intrinsic differences between these agents, we hypothesized that atenolol and metoprolol succinate would have disparate effects on vascular function. Methods: This study included 24 patients with hypertension (age 56 ± 2 years, 8 female, body mass index 28 ± 1) and featured a randomized, double-blind, crossover design. Each β-blocker (atenolol or metoprolol succinate) was taken by patients once daily for a 4-week period. Measures of vascular function included peripheral augmentation index (AIx) and pulse wave amplitude reactive hyperemia index from peripheral arterial tonometry, and brachial artery flow-mediated dilation from ultrasound. Results: There were similar reductions in mean arterial pressure following treatment with atenolol and metoprolol succinate. Compared with metoprolol succinate, there was a significant increase in peripheral AIx following atenolol therapy (P < 0.05). There were no changes in brachial artery flow-mediated dilation or pulse wave amplitude reactive hyperemia index following either drug treatment. Conclusions: Although atenolol and metoprolol succinate have similar effects on blood-pressure reduction, they have different effects on vascular function. Compared with metoprolol succinate, atenolol increases peripheral AIx. Neither drug has an effect on vascular endothelial function. These findings may have clinical implications, depending on the indication for treatment in an individual patient.

Influence of beta-blockers on endothelial function: A meta-analysis of randomized controlled trials

“…Similarly, there was no difference between the 2 nd generation beta-blockers: atenolol and metoprolol in the study of Heffernan et al [21], the mean FMD changes were: 0.70 ± ± 0.89 and 1.90 ± 0.89, respectively (p > 0.05).…”

Impact of Antihypertensive Agents on Central Systolic Blood Pressure and Augmentation Index: A Meta-Analysis

“…However, these confounders should play a limited role in the interpretation of our results as the change from baseline was assessed for all endpoints. Moreover, while studies were only included in the analysis if duration of treatment was at least 28 days, there was wide variance in the duration of the studies from 4 weeks 17,24,41,43,46,48,56,59,74,75,81 to 4 years. 61 Furthermore, the tonometry site for measurement of central hemodynamics varied amongst studies and a recent review of available techniques for measuring central BP cautioned that noninvasive cSBP estimation is device/technique-dependent.…”

Relation Between Digital Peripheral Arterial Tonometry and Brachial Artery Ultrasound Measures of Vascular Function in Patients With Coronary Artery Disease and in Healthy Volunteers

“…The cross-sectional design of our investigation, however, did not enable a cause-and-effect evaluation of either the direction of the observed correlations or the mechanisms underlying these peripheral vascular function phenotypes, and is a limitation. Moreover, we were unable to elucidate the direct impact of pharmacotherapy, including the anti-platelet effects of clopidogrel and anti-adrenergic effects of beta blockers, 28,29 on each phenotype in the CAD population. Future studies remain necessary to dissect the mechanisms underlying the digital PVA phenotype at baseline and following reactive hyperemia, and the impact of drug therapy.…”