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Different effects of fosinopril and atenolol on wave reflections in hypertensive patients
1Division of Cardiology, Veterans General Hospital-Taipei, Shih-Pai, Taiwan, ROC.
Insights
Fosinopril completely normalized arterial wave reflection in hypertensive patients, while atenolol showed a lesser effect. Both drugs effectively lowered blood pressure, but fosinopril offered superior central hemodynamic benefits.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is characterized by elevated peripheral blood pressure and often altered central arterial hemodynamics.
- Left ventricular mass is a key indicator of cardiovascular risk in hypertensive individuals.
- Arterial wave reflection, quantified by the augmentation index, plays a role in central blood pressure and cardiac workload.
Purpose of the Study:
- To compare the effects of fosinopril and atenolol on peripheral blood pressure, central arterial wave reflection, and left ventricular mass in patients with essential hypertension.
- To evaluate the impact of these antihypertensive agents on key cardiovascular parameters beyond simple blood pressure reduction.
Main Methods:
- A double-blind, randomized trial involving 79 hypertensive patients and 79 normotensive controls.
- Noninvasive carotid pressure waveform analysis using applanation tonometry to determine the augmentation index.
- Two-dimensional echocardiography for left ventricular mass index and 24-hour ambulatory blood pressure monitoring.
Main Results:
- Both fosinopril and atenolol significantly reduced 24-hour ambulatory systolic and diastolic blood pressures to similar extents.
- Fosinopril completely normalized the elevated augmentation index in hypertensive patients compared to normotensive controls (P < .002).
- Atenolol also reduced the augmentation index, but to a significantly lesser degree than fosinopril (P = .04 for comparison).
Conclusions:
- Fosinopril demonstrates superior efficacy over atenolol in improving central arterial hemodynamics by normalizing arterial wave reflection in essential hypertension.
- While both drugs effectively control peripheral blood pressure, fosinopril offers additional benefits for arterial stiffness and wave reflection.
- These findings suggest that fosinopril may provide greater cardiovascular protection by addressing central hemodynamic abnormalities in hypertensive patients.
Abstract:
We conducted this study to compare the effects of fosinopril versus atenolol on peripheral blood pressure, central arterial wave reflection, and left ventricular mass in a group of patients with essential hypertension. We conducted a double-blind, randomized trial of fosinopril and atenolol in 79 hypertensive patients (52 men, 27 women; mean age, 45.8 +/- 8.5 years; range, 30 to 68 years). Carotid pressure waveforms were recorded noninvasively by applanation tonometry with a Millar micromanometer-tipped probe. The extent of wave reflection was estimated by the augmentation index defined as the ratio of the amplitude of pressure wave above its systolic shoulder to the pulse pressure. The augmentation index, left ventricular mass index by two-dimensional echocardiography, and 24-hour ambulatory blood pressures were determined before and after 8 weeks of daily treatment with fosinopril (10 to 20 mg) or atenolol (50 to 100 mg) with or without diuretics and compared with those values in 79 normotensive control subjects. After 8 weeks of treatment, both drugs lowered 24-hour ambulatory peripheral systolic and diastolic pressures into the normal range to a similar extent (fosinopril, -18/-13 mm Hg; atenolol, -23/-17 mm Hg, both P = NS). On the other hand, whereas the elevated augmentation index in hypertensive patients compared with normotensive subjects (16 +/- 11% versus 10 +/- 8%) was completely normalized by fosinopril (-9.3 +/- 9.8%, P < or = .002), it was lowered by atenolol (-4.8 +/- 8.9%, P < .002) but to a significantly smaller extent (fosinopril versus atenolol effect, P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)