Impact of Concomitant Use of Beta blocker, Statin, Aspirin, and Metformin on Central Hemodynamics and Arterial Stiffness in Hypertension

Abstract

Hypertension has enormous prevalence, threatening future prediction, tremendous impact on cardiovascular health, and cost burden of pharmacotherapy. [1] Most studies of hypertension and pharmacotherapy focus on first-line anti-hypertensives and brachial blood pressure (bBP). BP is just one of many determinants of cardiovascular risk. [2] Parameters about functioning of aorta and heart are more discrete and direct in risk stratification. Routinely measured bBP does not tell about the status of aortic compliance and central hemodynamics. Similarly, along with the first-line anti-hypertensives, drugs such as aspirin, statin, beta-blocker (BB), and antidiabetic drugs are also used in hypertensives. BBs are usually used as the second-line agents with some specific indication and metformin as drug for type 2 diabetes in most cases. Statin is used to treat dyslipidemia, and aspirin is given to prevent ischemic heart disease. These preventive pharmacotherapies indicate both risk of underlying indicator for use as well as benefit offered by correction of the same by the drug. Frequency and concomitant use of these are expected more in our hypertensives with association of diabetes and heart disease in majority, as we previously documented. [3] These drugs are known to affect the pathology of essential hypertension individually and may have impact on some discrete aortic and central hemodynamic parameters.

Central hemodynamics and arterial stiffness in Gujarati diabetics not receiving any antihypertensive: A case–control study based on oscillometric pulse wave analysis

“…[13] It can also be due to (1) unavailability of HbA1c that gives better inference about glycemic control, (2) higher prevalence of physical inactivity, (3) poor blood pressure control, (4) ethnic predisposition, (5) delayed diagnosis, and (6) lack of life style modification. Diabetes and hypertension are interrelated,[14] and we found the same in treated diabetics in whom cardiovascular aging is not prevented by use of drugs such as beta blocker[5] or drugs affecting renin–angiotensin aldosterone system. [4] This accelerated cardiovascular profile indicates the increase in work load on heart that can produce adverse effect on itself and other target organ damages.…”

“…Nonhypertensive diabetics are monitored for brachial blood pressure (bBP) and not offered cardioprotective pharmacotherapy. [45] Hence, progression of cardiovascular aging continues in them adding to suboptimum glycemic control. There are limitations of bBP measurement.…”

Central hemodynamics and arterial stiffness by oscillometric pulse-wave analysis in treated Gujarati euglycemic hypertensives: A case-control study

“…Cases, being diagnosed and treated for at least 1 year, gave a chance to document the effect of disease on PWA-derived parameters after allowing the adequate benefit of blood pressure lowering and various other correlates for it. [15]…”