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Antihypertensive drugs and central blood pressure

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Abstract

Recent evidence suggests that central blood pressure is a more important determinant of cardiovascular risk than brachial pressure. Interestingly, antihypertensive drugs exert different effects on brachial and central pressure. Traditional β-blockers, such as atenolol, appear to have an adverse impact on central pressure, despite lowering brachial pressure. This may help to explain the results of recent large outcome studies using atenolol. Further research is required to clarify whether other antihypertensive agents lower central pressure beyond the effects observed on brachial pressure.

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References and Recommended Reading

  1. Remington JW, Wood EH: Formation of the peripheral pulse contour in man. J Applied Physiol 1956, 9:433–442.

    CAS  Google Scholar 

  2. Kroeker EJ, Wood EH: Comparison of simultaneously recorded central and peripheral arterial pressure pulses during rest, exercise and tilted position in man. Circ Res 1955, 3:623–632.

    PubMed  CAS  Google Scholar 

  3. McEniery CM, Yasmin, McDonnell B, et al.; on behalf of the Anglo-Cardiff Collaborative Trial Investigators: Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II. Hypertension 2008, 51:1476–1482.

    Article  PubMed  CAS  Google Scholar 

  4. Camacho F, Avolio A, Lovell NH: Estimation of pressure pulse amplification between aorta and brachial artery using stepwise multiple regression models. Physiol Meas 2004, 25:879–889.

    Article  PubMed  CAS  Google Scholar 

  5. Pauca AL, O’Rourke MF, Kon ND: Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001, 38:932–937.

    Article  PubMed  CAS  Google Scholar 

  6. Pauca AL, Kon ND, O’Rourke MF: The second peak of the radial artery pressure wave represents aortic systolic pressure in hypertensive and elderly patients. Br J Anaesth 2004, 92:651–657.

    Article  PubMed  CAS  Google Scholar 

  7. Takazawa K, Kobayashi H, Shindo N, et al.: Relationship between radial and central arterial pulse wave and evaluation of central aortic pressure using the radial arterial pulse wave. Hypertens Res 2007, 30:219–228.

    Article  PubMed  Google Scholar 

  8. Waddell TK, Dart AM, Medley TL, et al.: Carotid pressure is a better predictor of coronary artery disease severity than brachial pressure. Hypertension 2001, 38:927–931.

    Article  PubMed  CAS  Google Scholar 

  9. Philippe F, Chemaly E, Blacher J, et al.: Aortic pulse pressure and extent of coronary artery disease in percutaneous transluminal coronary angioplasty candidates. Am J Hypertens 2002, 15:672–677.

    Article  PubMed  Google Scholar 

  10. Lu TM, Hsu NW, Chen YH, et al.: Pulsatility of ascending aorta and restenosis after coronary angioplasty in patients >60 years of age with stable angina pectoris. Am J Cardiol 2001, 88:964–968.

    Article  PubMed  CAS  Google Scholar 

  11. Nakayama Y, Tsumura K, Yamashita N, et al.: Pulsatility of ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. Circulation 2000, 101:470–472.

    PubMed  CAS  Google Scholar 

  12. Saba PS, Roman MJ, Pini R, et al.: Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects. J Am Coll Cardiol 1993, 22:1873–1880.

    PubMed  CAS  Google Scholar 

  13. Boutouyrie P, Bussy C, Lacolley P, et al.: Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation 1999, 100:1387–1393.

    PubMed  CAS  Google Scholar 

  14. Tanaka H, Dinenno FA, Monahan KD, et al.: Carotid artery wall hypertrophy with age is related to local systolic blood pressure in healthy men. Arterioscler Thromb Vasc Biol 2001, 21:82–87.

    PubMed  CAS  Google Scholar 

  15. Levy D, Garrison R, Savage DD, et al.: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med 1990, 332:1561–1566.

    Article  Google Scholar 

  16. Simons PCG, Algra A, Bots ML, et al.: Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients: the SMART study (Second Manifestations of ARTerial disease). Circulation 1999, 100:951–957.

    PubMed  CAS  Google Scholar 

  17. Safar ME, Blacher J, Pannier B, et al.: Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002, 39:735–738.

    Article  PubMed  CAS  Google Scholar 

  18. Roman MJ, Devereux RB, Kizer JR, et al.: Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 2007, 50:197–203.

    Article  PubMed  CAS  Google Scholar 

  19. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.

    Article  Google Scholar 

  20. Staessen JA, Wang JG, Thijs L: Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 2001, 358:1305–1315.

    Article  PubMed  CAS  Google Scholar 

  21. Carlberg B, Samuelsson O, Lindholm LH: Atenolol in hypertension: Is it a wise choice? Lancet 2004, 364:1684–1689.

    Article  PubMed  CAS  Google Scholar 

  22. Lindholm LH, Carlberg B, Samuelsson O: Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005, 366:1545–1553.

    Article  PubMed  CAS  Google Scholar 

  23. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992, 304:405–412.

  24. Dahlöf B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:995–1003.

    Article  PubMed  Google Scholar 

  25. Dahlöf B, Sever PS, Poulter NR, et al.: Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005, 366:895–906.

    Article  PubMed  CAS  Google Scholar 

  26. Asmar RG, London GM, O’Rourke ME, Safar ME: Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol. Hypertension 2001, 38:922–926.

    Article  PubMed  CAS  Google Scholar 

  27. Williams B, Lacy PS, Thom SM, et al.: Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006, 113:1213–1225.

    Article  PubMed  CAS  Google Scholar 

  28. Deary AJ, Schumann AL, Murfet H, et al.: Influence of drugs and gender on the arterial pulse wave and natriuretic peptide secretion in untreated patients with essential hypertension. Clin Sci 2002, 103:493–499.

    Article  PubMed  CAS  Google Scholar 

  29. Morgan T, Lauri J, Bertram D, Anderson A: Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens 2004, 17:118–123.

    Article  PubMed  CAS  Google Scholar 

  30. Hirata K, Vlachopoulos C, Adji A, O’Rourke MF: Benefits from angiotensin-converting enzyme inhibitor ‘beyond blood pressure lowering’: Beyond blood pressure or beyond the brachial artery? J Hypertens 2005, 23:551–556.

    Article  PubMed  CAS  Google Scholar 

  31. Dhakam Z, McEniery CM, Yasmin, et al.: Atenolol and eprosartan: differential effects on central blood pressure and aortic pulse wave velocity. Am J Hypertens 2006, 19:214–219.

    Article  PubMed  CAS  Google Scholar 

  32. Dhakam Z, Yasmin, McEniery CM, et al.: A comparison of atenolol and nebivolol in isolated systolic hypertension. J Hypertens 2008, 26:351–356.

    Article  PubMed  CAS  Google Scholar 

  33. London GM, Pannier B, Guerin AP, et al.: Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade. Circulation 1994, 90:2786–2796.

    PubMed  CAS  Google Scholar 

  34. London GM, Pannier B, Vicaut E, et al.: Antihypertensive effects and arterial haemodynamic alterations during angiotensin converting enzyme inhibition. J Hypertens 1996, 14:1139–1146.

    Article  PubMed  CAS  Google Scholar 

  35. Mitchell GF, Izzo JL Jr, Lacourciere Y, et al.: Omapatrilat reduces pulse pressure and proximal aortic stiffness in patients with systolic hypertension: results of the conduit hemodynamics of omapatrilat international research study. Circulation 2002, 105:2955–2961.

    Article  PubMed  CAS  Google Scholar 

  36. Stokes GS, Barin ES, Gilfillan KL: Effects of isosorbide mononitrate and AII inhibition on pulse wave reflection in hypertension. Hypertension 2003, 41:297–301.

    Article  PubMed  CAS  Google Scholar 

  37. Ahimastos AA, Natoli AK, Lawler A, et al.: Ramipril reduces large-artery stiffness in peripheral arterial disease and promotes elastogenic remodeling in cell culture. Hypertension 2005, 45:1194–1199.

    Article  PubMed  CAS  Google Scholar 

  38. Dart AM, Cameron JD, Gatzka CD, et al.: Similar effects of treatment on central and brachial blood pressures in older hypertensive subjects in the Second Australian National Blood Pressure Trial. Hypertension 2007, 49:1242–1247.

    Article  PubMed  CAS  Google Scholar 

  39. Aznaouridis KA, Stamatelopoulos KS, Karatzis EN, et al.: Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients. J Hum Hypertens 2007, 21:654–663.

    Article  PubMed  CAS  Google Scholar 

  40. Jiang XJ, O’Rourke MF, Zhang YQ, et al.: Superior effect of an angiotensin-converting enzyme inhibitor over a diuretic for reducing aortic systolic pressure. J Hypertens 2007, 25:1095–1099.

    Article  PubMed  CAS  Google Scholar 

  41. Tropeano AI, Boutouyrie P, Pannier B, et al.: Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives. Hypertension 2006, 48:80–86.

    Article  PubMed  CAS  Google Scholar 

  42. Mahmud A, Feely J: Favourable effects on arterial wave reflection and pulse pressure amplification of adding angiotensin II receptor blockade in resistant hypertension. J Hum Hypertens 2000, 14:541–546.

    Article  PubMed  CAS  Google Scholar 

  43. Kelly RP, Millasseau SC, Ritter JM, Chowienczyk PJ: Vasoactive drugs influence aortic augmentation index independently of pulse-wave velocity in healthy men. Hypertension 2001, 37:1429–1433.

    PubMed  CAS  Google Scholar 

  44. Wilkinson IB, MacCallum H, Flint L, et al.: The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000, 525(Pt 1):263–270.

    Article  Google Scholar 

  45. Kelly R, Daley J, Avolio A, O’Rourke M: Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension. Hypertension 1989, 14:14–21.

    PubMed  CAS  Google Scholar 

  46. Boutouyrie P, Bussy C, Hayoz D, et al.: Local pulse pressure and regression of arterial wall hypertrophy during long-term antihypertensive treatment. Circulation 2000, 101:2601–2606.

    PubMed  CAS  Google Scholar 

  47. Kelly RP, Gibbs HH, O’Rourke MF, et al.: Nitroglycerine has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. Eur Heart J 1990, 11:138–144.

    PubMed  CAS  Google Scholar 

  48. Duchier J, Iannascoli F, Safar M: Antihypertensive effect of sustained-release isosorbide dinitrate for isolated systolic systemic hypertension in the elderly. Am J Cardiol 1987, 60:99–102.

    Article  PubMed  CAS  Google Scholar 

  49. Mancia G, De Backer G, Dominiczak A, et al.: 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 2007, 16:135–232.

    Article  Google Scholar 

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  1. Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital, Box 110, Cambridge, CB20QQ, UK

    Carmel M. McEniery

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Correspondence to Carmel M. McEniery.

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McEniery, C.M. Antihypertensive drugs and central blood pressure. Current Science Inc 11, 253–259 (2009). https://doi.org/10.1007/s11906-009-0043-4

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