Abstract
Objectiveβ-blockers (BBs) with different pharmacological properties may have heterogeneous effects on sympathetic nervous activity (SNA) and central aortic pressure (CAP), which are independent cardiovascular factors for hypertension. Hence, we analyzed the effects of bisoprolol and atenolol on SNA and CAP in hypertensive patients.MethodsThis was a prospective, randomized, controlled study in 109 never-treated hypertensive subjects randomized to bisoprolol (5 mg) or atenolol (50 mg) for 4–8 weeks. SNA, baroreflex sensitivity (BRS) and heart rate (HR) variability (HRV) were measured using power spectral analysis using a Finometer. CAP and related parameters were determined using the SphygmoCor device (pulse wave analysis).ResultsBoth drugs were similarly effective in reducing brachial BP. However, central systolic BP (−14±10 mm Hg vs −6±9 mm Hg; P<0.001) and aortic pulse pressure (−3±10 mm Hg vs +3±8 mm Hg; P<0.001) decreased more significantly with bisoprolol than with atenolol. The augmentation index at a HR of 75 bpm (AIxatHR75) was significantly decreased (29%±11% to 25%±12%; P = 0.026) in the bisoprolol group only. Furthermore, the change in BRS in the bisoprolol group (3.99±4.19 ms/mmHg) was higher than in the atenolol group (2.66±3.78 ms/mmHg), although not statistically significant (P>0.05). BRS was stable when RHR was controlled (RHR≤65 bpm), and the two treatments had similar effects on the low frequency/high frequency (HF) ratio and on HF.ConclusionBBs seem to have different effects on arterial distensibility and compliance in hypertensive subjects. Compared with atenolol, bisoprolol may have a better effect on CAP.Trial RegistrationClinicalTrials.gov NCT01762436
Highlights
The sympathetic nervous system (SNS) plays a role in the pathophysiology of chronic arterial hypertension by modifying cardiac output and peripheral vascular resistance [1,2]
Increasing clinical evidence suggests that central aortic pressure (CAP), but not brachial blood pressure (BP), predicts cardiovascular events, because the left ventricle (LV) pumps directly against the afterload in the central arteries
Mild-to-moderate essential hypertension (EH) was defined as a systolic BP of 140–160 mmHg and/or a diastolic BP of 90–100 mmHg on at least three different occasions separated by a month
Summary
The sympathetic nervous system (SNS) plays a role in the pathophysiology of chronic arterial hypertension by modifying cardiac output and peripheral vascular resistance [1,2]. Introduced into scientific practice, methods for SNA evaluation are not commonly used in a clinical setting. SNA, and can be found in clinical guidelines as basic assessment methods [5,6,7]. Data suggest that low BRS and/or HRV are risk factors for cardiovascular morbidity and mortality [8,9,10]. Increasing clinical evidence suggests that central aortic pressure (CAP), but not brachial BP, predicts cardiovascular events, because the left ventricle (LV) pumps directly against the afterload in the central arteries. Aortic systolic BP, pulse pressure (PP), and augmentation index (AIx) have been shown to be strong independent cardiovascular risk factors in hypertensive populations [11,12,13,14,15]
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