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 .
Effects of atenolol, perindopril and verapamil on haemodynamic and vascular function in Marfan syndrome - a randomised, double-blind, crossover trial.
BACKGROUND Aortic dilatation is the main therapeutic target in patients with Marfan syndrome . St and ard treatment with a β-blocker may not lower central pulse pressure - the major objective - because it does not do so in hypertension , unlike angiotensin-converting enzyme inhibitors and calcium-channel blockers . We therefore performed a prospect i ve , r and omised , double-blind , crossover trial to compare the effects of these three agents on large artery function and central aortic pressure in patients with Marfan syndrome . METHODS AND RESULTS Eighteen patients had applanation tonometry , pulse wave analysis and echocardiography , before and after atenolol 75 mg , perindopril 4 mg and verapamil 240 mg , each given for 4 weeks , in a r and om order , with 2 weeks between medications . Fourteen patients completed the study . Within-drug comparisons demonstrated that perindopril ( -10·3 mmHg , P = 0·002 ) , verapamil ( -9·2 mmHg , P = 0·003 ) and atenolol ( -7·1 mmHg , P = 0·01 ) all reduced central systolic pressure and brachial pressure ; central changes were least , and peripheral changes greatest with atenolol but between-drug comparisons ( analysis of covariance ) were not significant . There was a trend for augmentation to be reduced by perindopril ( -6·3 % , P = 0·05 ) , verapamil ( -5·5 % , P = 0·07 ) and atenolol ( -3·2 % , P = 0·09 ) . Only atenolol  reduced heart rate ( by 16 % ) and delayed expansion in the arch and abdominal aorta ( by 8 % and 11 % ) ( P < 0·001 , P < 0·01 and P < 0·05 , respectively , for between-drug comparisons ) . CONCLUSIONS Perindopril , verapamil and atenolol all reduced peripheral and central systolic pressure . As atenolol slowed heart rate and delayed aortic wave travel , β-blockade may have a continuing role in the treatment of patients with Marfan syndrome
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 .