Sluyter, JD;
Hughes, AD;
Lowe, A;
Parker, KH;
Camargo, CA;
Hametner, B;
Wassertheurer, S;
(2016)
Different associations between beta-blockers and other antihypertensive medication combinations with brachial blood pressure and aortic waveform parameters.
International Journal of Cardiology
, 219
pp. 257-263.
10.1016/j.ijcard.2016.06.051.
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Abstract
BACKGROUND: Comparing the relationships of antihypertensive medications with brachial blood pressure (BP) and aortic waveform parameters may help clinicians to predict the effect on the latter in brachial BP-based antihypertensive therapy. We aimed to make such comparisons with new waveform measures and a wider range of antihypertensive regimens than examined previously. METHODS: Cross-sectional analysis of 2933 adults (61% male; aged 50–84 years): 1637 on antihypertensive treatment and 1296 untreated hypertensives. Sixteen medicine regimens of up to 4 combinations of drugs from 6 antihypertensive classes were analysed. Aortic systolic BP, augmentation index (AIx), excess pressure integral (EPI), backward pressure amplitude (Pb), reflection index (RI) and pulse wave velocity (PWV) were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. RESULTS: Forest plots of single-drug class comparisons across regimens with the same number of drugs (for between 1- and 3-drug regimens) revealed that AIx, Pb, RI and/or loge(EPI) were higher (maximum difference = 5.6%, 2.2 mm Hg, 0.0192 and 0.13 loge(mm Hg ⋅ s), respectively) with the use of a beta-blocker compared with vasodilators and diuretics, despite no brachial systolic and diastolic BP differences. These differences were reduced (by 34–57%) or eliminated after adjustment for heart rate, and similar effects occurred when controlling for systolic ejection period or diastolic duration. CONCLUSIONS: Beta-blocker effects on brachial BP may overestimate effects on aortic waveform parameters. Compared to other antihypertensives, beta-blockers have weaker associations with wave reflection measures and EPI; this is predominantly due to influences on heart rate.
| Type: | Article |
|---|---|
| Title: | Different associations between beta-blockers and other antihypertensive medication combinations with brachial blood pressure and aortic waveform parameters |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.ijcard.2016.06.051 |
| Publisher version: | http://dx.doi.org/10.1016/j.ijcard.2016.06.051 |
| Language: | English |
| Additional information: | Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Keywords: | Arterial stiffness; Beta-blocker; Central blood pressure; Pulse waveform; Vasodilating antihypertensive agents; Wave reflection |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1503326 |
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