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 .
Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study.
BACKGROUND Different blood pressure (BP)-lowering drugs could have different effects on central aortic pressures and thus cardiovascular outcome despite similar effects on brachial BP . The Conduit Artery Function Evaluation ( CAFE ) study , a sub study of the Anglo-Sc and inavian Cardiac Outcomes Trial ( ASCOT ) , examined the impact of 2 different BP lowering-regimens ( atenolol+/-thiazide-based versus amlodipine+/-perindopril-based therapy ) on derived central aortic pressures and hemodynamics . METHODS AND RESULTS The CAFE study recruited 2199 patients in 5 ASCOT centers . Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressures and hemodynamic indexes on repeated visits for up to 4 years . Most patients received combination therapy throughout the study . Despite similar brachial systolic BPs between treatment groups ( Delta0.7 mm Hg ; 95 % CI , -0.4 to 1.7 ; P=0.2 ) , there were substantial reductions in central aortic pressures with the amlodipine regimen ( central aortic systolic BP , Delta4.3 mm Hg ; 95 % CI , 3.3 to 5.4 ; P<0.0001 ; central aortic pulse pressure , Delta3.0 mm Hg ; 95 % CI , 2.1 to 3.9 ; P<0.0001 ) . Cox proportional-hazards modeling showed that central pulse pressure was significantly associated with a post hoc-defined composite outcome of total cardiovascular events/ procedures and development of renal impairment in the CAFE cohort ( unadjusted , P<0.0001 ; adjusted for baseline variables , P<0.05 ) . CONCLUSIONS BP-lowering drugs can have substantially different effects on central aortic pressures and hemodynamics despite a similar impact on brachial BP . Moreover , central aortic pulse pressure may be a determinant of clinical outcomes , and differences in central aortic pressures may be a potential mechanism to explain the different clinical outcomes between the 2 BP treatment arms in ASCOT
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 .