In conclusion , NVBBs , but not VBBs , determine a lower reduction in cSBP than in pSBP .
However , the difference in treatment-induced SBP amplification changes between NVBB and VBB is nearly abolished after accounting for differences in heart rate changes
β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure ( cSBP ) as compared with peripheral SBP ( pSBP ) .
Whether this effect is less pronounced with vasodilating β-blockers ( VBB ) when compared with nonvasodilating β-blockers ( NVBB ) remains unsettled .
Central versus peripheral blood pressure in malignant hypertension; effects of antihypertensive treatment.
BACKGROUND Sodium nitroprusside ( SNP ) and labetalol are recommended for the immediate treatment of malignant hypertension . Both are intravenous agents but have different effects on systemic hemodynamics , and may have differential effects on pulse-wave reflection and pulse-pressure amplification , with consequences for peripheral versus central blood pressures ( BPs ) . METHODS We conducted a nonr and omized , open-label study of 8 patients treated with sodium nitroprusside ( mean age ( ±SD ) , 44±14 years ; 6 males ; diastolic/systolic BP , 225±22/135±8 mm Hg ) and 6 patients treated with intravenous labetalol ( mean age , 39±15 years ; 4 males ; systolic/diastolic BP , 232±22/138±17 mm Hg ) before and after treatment for malignant hypertension , aim ing at a 25 % reduction in mean arterial pressure . We measured peripheral pressures with an intra-arterial catheter in the radial artery and derived central pressures with a generalized transfer filter . RESULTS Mean arterial pressure was similarly reduced with sodium nitroprusside and labetalol ( by 27 % and 30 % , respectively ; P = 0.76 ) . There was a nonsignificantly greater reduction in peripheral systolic blood pressure ( SBP )  with labetalol than with sodium nitroprusside ( 29±11 % vs. 18±7 % , P = 0.08 ) . The decline in peripheral diastolic blood pressure ( DBP ) with the two agents was comparable , whereas the reduction in peripheral pulse pressure was 8±16 % with SNP and 33±17 % with labetalol ( P = 0.01 ) . The decline in reflection magnitude was greater with SNP than with labetalol . There were no significant differences in the reduction of central BP  with SNP and labetalol . The amplification of PP increased with SNP but did not change with labetalol . CONCLUSIONS We found no difference in central SBP or PP in subjects treated with SNP and labetalol , but labetalol produced a greater reduction in peripheral SBP and PP in the immediate treatment of malignant hypertension
In conclusion , NVBBs , but not VBBs , determine a lower reduction in cSBP than in pSBP .
However , the difference in treatment-induced SBP amplification changes between NVBB and VBB is nearly abolished after accounting for differences in heart rate changes
β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure ( cSBP ) as compared with peripheral SBP ( pSBP ) .
Whether this effect is less pronounced with vasodilating β-blockers ( VBB ) when compared with nonvasodilating β-blockers ( NVBB ) remains unsettled .