Comparison of atenolol versus bisoprolol with noninvasive hemodynamic and pulse wave assessment.

We aimed to compare atenolol versus bisoprolol regarding general hemodynamics, central-peripheral blood pressure (BP), pulse wave parameters, and arterial stiffness. In this open-label, crossover study, we recruited 19 hypertensives, untreated or with stable monotherapy. Patients were randomized to receive atenolol (25-50 mg) or bisoprolol (2.5-5 mg), and then switched medications after 4 weeks. Studies were performed at baseline and after each drug period. In pulse wave analyses, both drugs significantly increased augmentation index (P < .01) and ejection duration (P < .02), and reduced heart rate (P < .001), brachial systolic BP (P ≤ .01), brachial diastolic BP (P ≤ .001), and central diastolic BP (P ≤ .001), but not central systolic BP (P ≥ .06). Impedance cardiographic assessment showed a significantly increased stroke volume (P ≤ .02). There were no significant differences in the effects between drugs. In conclusion, atenolol and bisoprolol show similar hemodynamic characteristics. Failure to decrease central systolic BP results from bradycardia with increased stroke volume and an earlier reflected aortic wave.

Predictors of masked hypertension among treated hypertensive patients: an interesting association with orthostatic hypertension.

BACKGROUND: Masked hypertension (MH) entails an increased cardiovascular risk. Therefore, it is important to identify those individuals who would benefit the most from out-of-office blood pressure (BP) measurement. We sought to determine the prevalence and identify predictors of MH among adult hypertensive patients under treatment. METHODS: Treated hypertensive patients aged ≥ 18 years underwent office (duplicate sitting and standing BP in 1 visit) and home BP measurements (duplicate measurements for 4 days in the morning, afternoon, and evening; at least 16 measurements) and completed a questionnaire regarding risk factors and history of cardiovascular disease. MH was defined as normal office BP (<140/90mm Hg) with elevated home BP (≥135/85mm Hg, average of all readings discarding first day measurements). Patients with a systolic BP rise upon standing ≥5mm Hg were considered to have orthostatic hypertension (OHT). Variables indentified as relevant predictors of MH were entered into a multivariable logistic regression analysis model. RESULTS: Three hundred and four patients were included (mean age = 66.7 ±13.8; 67.4% women). The prevalence of MH in the whole population was 12.4% and was 20.9% among patients with office-controlled hypertension. Factors independently associated with MH were age (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.03-1.14), high-normal office systolic BP (OR = 5.61, 95% CI = 1.39-22.57), history of peripheral artery disease (PAD) (OR = 8.83, 95% CI = 1.5-51.84), moderate alcohol consumption (OR = 0.08, 95% CI = 0.01-0.73), and OHT (OR = 3.65, 95% CI = 1.27 to 10.51). CONCLUSIONS: Easily measurable parameters such as age, office systolic BP, history of PAD, and OHT may help to detect a population at risk of MH that would benefit from home BP monitoring.

Noninvasive hemodynamic assessment of the effect of mean arterial pressure on the amplitude of pulse pressure.

BACKGROUND: The present study compares the relationships between mean arterial pressure (MAP) and pulse pressure (PP) in young and older men and whether MAP determines age-related changes in PP. METHODS: Impedance cardiography was used to evaluate systemic hemodynamics noninvasively in 189 unmedicated men referred to our hypertension unit. Patients were divided by age according to the median value (< and >/=40 years). RESULTS: In younger patients, increasing supine MAP was associated with a transition in the blood pressure pattern from systolic to diastolic, whereas in older patients, increasing MAP was associated with change from diastolic to systolic hypertension. In young patients elevation in MAP was associated with a parallel decrease in PP (P < .001) and stroke volume index (SVI) (P < .001), whereas in older patients higher MAP was associated with higher PP (P < .001) and PP/SVI ratio (P < .001), a measure of arterial stiffness. When the sample was divided according to the median value of MAP (< and >/=101 mm Hg), differences in the age-related change in PP and SVI became apparent. With a lower MAP, changes in PP and SVI remained parallel until the sixth decade, after which they began a progressive dissociation. In contrast, at higher MAP, the dissociation between PP and SVI began two decades earlier, indicating an acceleration of the age-related increase in arterial stiffness. Therefore, the relationship between MAP and PP was negative in younger men at the expense of a decrease in SVI, and positive in older men due to increasing arterial stiffness. CONCLUSIONS: Noninvasive hemodynamic parameters from impedance cardiography provide a useful method to characterize the mechanism of increased blood pressure.