Abstract
Background: Antihypertensive treatment may have different effects on central arterial hemodynamics. The extent of the difference in effects between various antihypertensive drugs remains undefined.Methods: We conducted a systematic review and meta-analysis of randomized controlled trials that explored the effects of antihypertensive agents on both central and peripheral systolic blood pressure (SBP) and pulse pressure (PP) or central augmentation index, with a special focus on the comparison between newer [renin-angiotensin-aldosterone system (RAS) inhibitors and calcium-channel blockers (CCBs)] and older antihypertensive agents (diuretics and β- and α-blockers).Results: In total, 20 studies (n = 2,498) were included. Compared with diuretics (10 studies), β-blockers (16 studies), or an α-blocker (1 study), RAS inhibitors (21 studies), and CCBs (6 studies) more efficaciously (P < 0.001) reduced both central and peripheral SBP by a weighted mean difference of −5.63 (−6.50 to −4.76 mmHg) and −1.97 mmHg (−2.99 to −0.95 mmHg), respectively. Compared with older agents, the newer agents also more efficaciously (P < 0.001) reduced central PP (−3.27 mmHg; −4.95 to −1.59 mmHg), augmentation index (−6.11%; −7.94 to −4.29) and augmentation (−3.35 mmHg; −5.28 to –1.42 mmHg) but not peripheral PP (p ≥ 0.09). Accordingly, the newer agents reduced central-to-peripheral PP amplification significantly less than the older agents (0.11 mmHg; 0.05 to 0.17 mmHg; P < 0.001).Conclusion: Newer agents, such as RAS inhibitors and CCBs, were significantly more efficacious than older agents in their effects on central hemodynamics.
Highlights
When the blood flows from the central large elastic aorta to the peripheral smaller muscular arteries, systolic blood pressure (SBP) increases, without significant changes in diastolic blood pressure and mean arterial pressure, resulting in widened pulse pressure (PP)
We conducted a systematic review and meta-analysis of randomized controlled trials that explored the effects of antihypertensive agents on both central and peripheral systolic blood pressure (SBP) and pulse pressure (PP) or central augmentation index, with a special focus on the comparison between newer [reninangiotensin-aldosterone system (RAS) inhibitors and calcium-channel blockers (CCBs)] and older antihypertensive agents
Several studies have shown that the association between target-organ damage and SBP and PP is stronger for the central arteries than the brachial arteries (Kollias et al, 2016)
Summary
When the blood flows from the central large elastic aorta to the peripheral smaller muscular arteries, systolic blood pressure (SBP) increases, without significant changes in diastolic blood pressure and mean arterial pressure, resulting in widened pulse pressure (PP). Several studies have shown that the association between target-organ damage and SBP and PP is stronger for the central arteries than the brachial arteries (Kollias et al, 2016). The Conduit Artery Function Evaluation (CAFE) study, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), showed that treatment with amlodipine/perindopril was more efficacious than with atenolol/bendroflume thiazide in reducing central SBP and PP by 4.3 and 3.0 mmHg, respectively, despite similar reductions in the brachial arteries (Williams et al, 2006). The cardiovascular benefits of treatment with amlodipine and perindopril observed in ASCOT (Dahlöf et al, 2005) might have been resulted at least in part from the lowering of central blood pressure, other hemodynamic effects, such as reduced blood pressure variability, might have played a part (Rothwell et al, 2010). The extent of the difference in effects between various antihypertensive drugs remains undefined
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