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 .
Benefits from angiotensin-converting enzyme inhibitor ‘beyond blood pressure lowering’: beyond blood pressure or beyond the brachial artery?
Objective The substantial benefits of ramipril over conventional therapy in high-risk patients are not always associated with clinical ly significant differences in brachial arterial pressure , and largely remain unexplained . We undertook this acute study to establish the magnitude of and reason for different acute effects of ramipril and atenolol on arterial pressure . Methods We enrolled 30 patients , who took 10 mg ramipril , 100 mg atenolol , and placebo at intervals of ≥ 7 days , in a r and omized , double-blind , placebo-controlled trial . After baseline , measurements were taken at 30–60 min intervals for 5 h , and comprised cuff brachial pressure , radial artery tonometry with generation of central aortic pressure , and pulse wave velocity for aorta , upper limb and lower limb arteries . Results Both ramipril and atenolol  reduced arterial pressure , and the diastolic pressure fall was similar in the aorta and brachial artery , but the systolic pressure fall for ramipril was greater than for atenolol ( by 5.2 mmHg , P < 0.0001 ) in the aorta compared with the brachial artery . The aortic systolic pressure difference with ramipril in comparison with atenolol was accompanied by an absolute difference of 10.7 % ( P < 0.0001 ) in the augmentation index , denoting a reduction in peripheral wave reflection by ramipril . The aortic pulse wave velocity fell to a similar degree with ramipril in comparison with atenolol , but fell to a greater degree ( 1.35 and 0.44 m/s , respectively , P < 0.0001 for both ) in muscular arteries of the lower and upper limbs . Conclusion A greater ( average , 5.2 mmHg ) decrease in aortic systolic pressure caused by ramipril may explain the greater benefit of ramipril over atenolol . The difference is attributable to decreased stiffness of peripheral arteries and a reduction in wave reflection
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 .