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Long-term reduction of peripheral resistance with celiprolol and effects on left ventricular mass
B Trimarco1, G Lembo, N DeLuca
1First Clinica Medica, Second Faculty of Medicine, University of Naples, Italy.
Insights
Celiprolol and metoprolol effectively lower blood pressure in hypertensive patients. However, celiprolol improves forearm blood flow and reduces peripheral resistance, unlike metoprolol.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Hypertension management often involves beta-blockers.
- Understanding the hemodynamic effects of different beta-blockers is crucial for optimizing treatment.
- Celiprolol is a novel beta-blocker with potential antihypertensive properties.
Purpose of the Study:
- To compare the antihypertensive efficacy of celiprolol versus metoprolol.
- To investigate the systemic and forearm hemodynamic effects of both drugs.
- To assess cardiac performance and left ventricular remodeling.
Main Methods:
- Double-blind, randomized, crossover study in 20 hypertensive patients.
- Echocardiography and two-dimensional pulsed Doppler flowmetry used for hemodynamic assessment.
- 18-week study duration with 6-week active treatment periods and 2-week placebo periods.
Main Results:
- Both celiprolol and metoprolol reduced systolic and diastolic blood pressure by approximately 10%.
- Celiprolol decreased forearm and total peripheral resistance, increased forearm blood flow, and maintained cardiac output.
- Metoprolol reduced cardiac output by decreasing heart rate but did not alter stroke volume; neither drug affected cardiac performance or left ventricular mass.
Conclusions:
- Celiprolol and metoprolol exhibit comparable antihypertensive efficacy.
- Distinct hemodynamic profiles exist: celiprolol improves peripheral circulation, while metoprolol affects heart rate.
- These hemodynamic differences may explain varied patient responses to antihypertensive therapy.
Abstract:
The antihypertensive efficacy of a new beta-blocker, celiprolol, was compared with that of a well established antihypertensive drug, metoprolol. Systemic and forearm haemodynamic effects were investigated using echocardiography and two-dimensional pulsed Doppler flowmetry, respectively. Twenty hypertensive patients completed the double-blind crossover randomized study. Each 6-week active treatment period was both preceded and followed by 2 weeks of placebo treatment such that the total duration of the study was 18 weeks. Despite comparable efficacy in reducing systolic and diastolic blood pressures by approximately 10% of the basal value, the two drugs differed in their systemic and haemodynamic effects. Celiprolol significantly decreased forearm peripheral resistance and total peripheral resistance. Cardiac output remained unchanged and forearm blood flow was increased. Metoprolol reduced cardiac output through a reduction in heart rate, but stroke volume was unaltered. Neither drug significantly modified cardiac performance, as evaluated by left ventricular circumferential fibre shortening and left ventricular ejection fraction. Differences in the systemic and regional haemodynamic effects of the two drugs could account for the different blood pressure response seen in some patients. There was no observable change in left ventricular wall thickness or left ventricular mass. These results confirm previous reports which demonstrate that antihypertensive treatment with beta-blockers does not reduce left ventricular mass in patients with a left ventricle of normal size. It is generally accepted, however, that the ability of beta-blockers to reverse left ventricular hypertrophy is unrelated to the individual pharmacological characteristics of each agent.