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Antihypertensive Treatment and Central Arterial Hemodynamics: A Meta-Analysis of Randomized Controlled Trials

Yi-Bang Cheng1, Jia-Hui Xia1, Yan Li1

  • 1Shanghai Key Laboratory of Hypertension, Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Institute of Hypertension, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Frontiers in Physiology
|December 13, 2021
PubMed

Insights

Newer antihypertensive drugs like renin-angiotensin-aldosterone system inhibitors and calcium-channel blockers significantly improve central hemodynamics compared to older drug classes. These newer agents more effectively reduce central blood pressure and pulse pressure, enhancing cardiovascular health outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Antihypertensive treatments exhibit varied effects on central arterial hemodynamics.
  • The comparative efficacy of different antihypertensive drug classes on central hemodynamics is not well-defined.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials comparing newer antihypertensive agents (RAS inhibitors, CCBs) with older agents (diuretics, beta-blockers, alpha-blockers).
  • To assess the differential effects of these drug classes on central and peripheral systolic blood pressure and pulse pressure.

Main Methods:

  • Systematic review and meta-analysis of 20 randomized controlled trials involving 2,498 participants.
  • Focused on comparing the effects of renin-angiotensin-aldosterone system inhibitors and calcium-channel blockers against diuretics, beta-blockers, and alpha-blockers.
  • Analyzed changes in central and peripheral systolic blood pressure, pulse pressure, and central augmentation index.

Main Results:

  • Renin-angiotensin-aldosterone system inhibitors and calcium-channel blockers significantly reduced central and peripheral systolic blood pressure more effectively than older agents.
  • Newer agents demonstrated superior efficacy in reducing central pulse pressure, augmentation index, and augmentation compared to older agents.
  • Newer agents also significantly reduced central-to-peripheral pulse pressure amplification, unlike older agents.

Conclusions:

  • Newer antihypertensive agents, specifically renin-angiotensin-aldosterone system inhibitors and calcium-channel blockers, offer superior benefits for central hemodynamics.
  • These findings highlight the importance of drug class selection for optimizing central hemodynamic effects in hypertension management.

Keywords:
antihypertensive treatmentaugmentation indexcentral blood pressuredrugrandomized controlled trial

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