Differences in the Magnitude of Wave Reflection Account for Differential Effects of Amlodipine- Versus Atenolol-Based Regimens on Central Blood Pressure
- 1 October 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 54 (4), 724-730
- https://doi.org/10.1161/hypertensionaha.108.125740
Abstract
Antihypertensive agents may differ in their effects on central systolic blood pressure, and this may contribute to treatment-related differences in cardiovascular outcomes. In a substudy of the Anglo-Scandinavian Cardiac Outcome Trial, we investigated whether directly measured carotid systolic blood pressure differed between people randomized to amlodipine- and atenolol-based therapies and whether this is accounted for by differences in wave reflection patterns. Additional analysis was undertaken to establish whether differences in carotid systolic blood pressure predicted left ventricular mass, accounting for between-treatment differences in left ventricular mass index. Blood pressure and flow velocity were measured in the right carotid artery of 259 patients. Wave intensity analysis was used to separate and quantify forward and backward waves. Brachial blood pressure did not differ significantly between groups, but carotid systolic blood pressure (127 [12] versus 133 [15] mm Hg; P P =0.01), and wave reflection index (19.8% [10.9%] versus 23.3% [13.3%]; P =0.02) were significantly lower in patients randomized to amlodipine-based therapy. Left ventricular mass index was also lower in this group, and adjustment for carotid blood pressure attenuated treatment differences to a greater extent than brachial blood pressure. Carotid systolic blood pressure was also a significant independent predictor of left ventricular mass index in a multivariate model. Carotid systolic blood pressure is lower in people randomized to amlodipine-based compared with atenolol-based treatment despite there being no significant difference in brachial blood pressure. This difference is attributable to a lesser magnitude of wave reflection in patients randomized to the amlodipine-based regimen.Keywords
This publication has 34 references indexed in Scilit:
- Ethnicity and Left Ventricular Diastolic Function in Hypertension: An ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) SubstudyJournal of the American College of Cardiology, 2008
- Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial PressureHypertension, 2007
- Similar Effects of Treatment on Central and Brachial Blood Pressures in Older Hypertensive Subjects in the Second Australian National Blood Pressure TrialHypertension, 2007
- Letter by Cameron et al Regarding Article, “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
- Letter by Dart et al Regarding Article, “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
- Evidence of a Dominant Backward-Propagating “Suction” Wave Responsible for Diastolic Coronary Filling in Humans, Attenuated in Left Ventricular HypertrophyCirculation, 2006
- Wave-energy patterns in carotid, brachial, and radial arteries: a noninvasive approach using wave-intensity analysisAmerican Journal of Physiology-Heart and Circulatory Physiology, 2005
- Determination of wave speed and wave separation in the arteriesJournal of Biomechanics, 2001
- Forward and Backward Running Waves in the Arteries: Analysis Using the Method of CharacteristicsJournal of Biomechanical Engineering, 1990
- Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart StudyThe New England Journal of Medicine, 1990