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J Hypertens. 2016 Aug;34(8):1535-43. doi: 10.1097/HJH.0000000000000978.

Heart rate dependent and independent effects of beta-blockers on central hemodynamic parameters: a propensity score analysis.

Author information

1
aHôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal bCHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, Québec, Canada.

Abstract

OBJECTIVES:

Central hemodynamic parameters are better predictors of the cardiovascular burden than peripheral blood pressure (BP). Beta-blockers are known to reduce central BP to a lesser extent than peripheral BP, a hypothesized mechanistic consequence of heart rate (HR) reduction.

METHODS:

The association between beta-blocker use, HR and central hemodynamics indices was studied in treated hypertensive participants of the CARTaGENE study using propensity score analyses and multivariate linear regressions.

RESULTS:

Of the 20 004 participants, 2575 were treated hypertensive patients with valid pulse wave analysis. Using propensity score analyses, beta-blocker users (n = 605) were matched to nonusers having similar clinical characteristics with (Model 1) and without (Model 2) adjustment for HR. This resulted in 457 and 510 pairs with adequate balance, except for a HR difference in Model 2 (62.5 ± 10.5 vs. 70.4 ± 11.5 bpm, p < 0.001). In Model 1, the central pulse pressure (PP) was 46.5 ± 12.9 mmHg with beta-blocker compared with 45.4 ± 11.0 mmHg without (p = 0.045). PP amplification, augmentation index and augmented pressure were also less favorable with the use of beta-blocker. The HR difference in Model 2 further increased the difference in central PP observed with beta-blocker to 46.5 ± 13.0 vs. 43.3 ± 11.3 without (p < 0.001). These findings were similar when atenolol, metoprolol and bisoprolol were assessed separately using multivariate linear regression models.

CONCLUSION:

This study shows that the unfavorable central hemodynamic profile of beta-blocker has both HR-dependent and HR-independent components that are similar for all frequently used β1-selective beta-blocker.

PMID:
27219487
DOI:
10.1097/HJH.0000000000000978
[Indexed for MEDLINE]

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