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Different aortic reflection wave responses following long-term angiotensin-converting enzyme inhibition and
B M Pannier1, A P Guerin, S J Marchais
1Centre Hospitalier FH Manhes, Fleury-Mérogis, France.
Insights
Both perindopril (an ACE inhibitor) and atenolol (a beta-blocker) effectively lower blood pressure in hypertensive patients. Perindopril uniquely reduced arterial wave reflections, while atenolol more significantly improved aortic stiffness.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Physiology
Background:
- Arterial hypertension is characterized by elevated central systolic and pulse pressures, influenced by aortic wave reflections.
- Understanding the impact of antihypertensive medications on these hemodynamic parameters is crucial for effective treatment.
Purpose of the Study:
- To assess central pressure alterations in the carotid artery after 1 month of treatment with perindopril or atenolol.
- To investigate hemodynamic changes within 8 hours of drug intake.
Main Methods:
- A double-blind, randomized cross-over study involving 20 hypertensive patients.
- Comparison of perindopril (ACE inhibitor) and atenolol (beta-blocker) over 4-week treatment periods.
- Serial measurements of brachial and carotid artery pressures, pulse wave velocity, and aortic wave reflections.
Main Results:
- Both perindopril and atenolol reduced brachial and carotid artery pressures.
- Atenolol decreased heart rate and pulse wave velocity more significantly than perindopril.
- Perindopril significantly reduced arterial wave reflections, an effect not observed with atenolol.
Conclusions:
- Both ACE inhibitors and beta-blockers improve central pulse pressure in hypertension.
- Perindopril uniquely reduces arterial wave reflections, while atenolol demonstrates a greater effect on aortic stiffness.
- These distinct mechanisms contribute to improved central hemodynamics in hypertensive patients.
Abstract:
1. In arterial hypertension, aortic wave reflections contribute to determining central systolic and pulse pressures. The present study assessed the central pressure alterations at the level of the common carotid artery following 1 month treatment with perindopril or atenolol and investigated during the 8 h following drug intake. 2. Twenty patients suffering from permanent hypertension were included after a 4 week run-in placebo period in a double-blind, randomized cross-over study comparing the angiotensin-converting enzyme (ACE) inhibitor perindopril with the beta-blocker atenolol during a 4 week treatment period. 3. Before and during the 8 h after drug intake, serial measurements included brachial artery systolic and diastolic blood pressures (SBP and DBP, respectively; mercury sphygmomanometer), carotid artery SBP and pulse pressure (PP; applanation tonometry), aortic pulse wave velocity (Complior; Colson, Les Lilas, France) and arterial wave reflections from the aorta (applanation tonometry; Sphygmocor; PWV Medical, Sydney, NSW, Australia). 4. Both treatments decreased brachial and carotid artery SBP, DBP and PP. Heart rate and pulse wave velocity decreased following atenolol (P < 0.001). Pulse wave velocity was reduced slightly following perindopril (NS). Arterial wave reflections were significantly (P < 0.001) decreased with perindopril in comparison with atenolol, but this effect on wave reflections was not associated with a larger decrease in carotid artery PP. 5. Thus, during chronic treatment, ACE inhibition and selective beta1-adrenoceptor blockade resulted in a similar decrease in brachial and carotid artery PP, but only atenolol reduced heart rate. Aortic pulse wave velocity was reduced with both drugs, but atenolol appeared more effective in improving aortic stiffness. Arterial wave reflections were decreased only following perindopril. 6. Central pulse pressure was improved following 1 month treatment with an ACE inhibitor or beta-adrenoceptor blockade following a decrease in arterial wave reflections with perindopril and a higher decrease in regional aortic stiffness with atenolol.