Different associations between beta-blockers and other antihypertensive medication combinations with brachial blood pressure and aortic waveform parameters

• Published in: International journal of cardiology 2016-09, Vol.219, p.257-263
• Main Authors: Sluyter, John D, Hughes, Alun D, Lowe, Andrew, Parker, Kim H, Camargo, Carlos A, Hametner, Bernhard, Wassertheurer, Siegfried, Scragg, Robert K.R
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Ankle Brachial Index - methods; Antihypertensive Agents - administration & dosage; Aorta - drug effects; Aorta - physiology; Arterial stiffness; Beta-blocker; Blood Pressure - drug effects; Blood Pressure - physiology; Blood Pressure Determination - methods; Calcium Channel Blockers - administration & dosage; Cardiovascular; Central blood pressure; Cross-Sectional Studies; Diuretics - administration & dosage; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pulse Wave Analysis - methods; Pulse waveform; Vasodilating antihypertensive agents; Wave reflection
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.06.051

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.