Value of haemodynamic profiling to the response of antihypertensive therapy

M. Serg; J. Graggaber; P. Kampus; M. Zagura; J. Kals; K. Mäki-Petäjä; J. Cheriyan; M. Zilmer; J. Eha; C. M. McEniery; I. B. Wilkinson

doi:10.1016/j.artres.2014.07.004

Value of haemodynamic profiling to the response of antihypertensive therapy

M. Serg^*, J. Graggaber, P. Kampus, M. Zagura, J. Kals, K. Mäki-Petäjä, J. Cheriyan, M. Zilmer, J. Eha, C. M. McEniery, I. B. Wilkinson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Background: Essential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients.

Methods: In this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4mg, candesartan 16mg, bisoprolol 5mg, isosorbide mononitrate (ISMN) 50mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug.

Results: Baseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7-28.9%) and high PPA (1.22-1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3-48.2%) and low PPA (1.05-1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels.

Conclusions: Our study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results.

Clinical Trials Registry number: EudraCT 2006-006981-40.

Original language	English
Pages (from-to)	189-196
Number of pages	8
Journal	Artery Research
Volume	8
Issue number	4
DOIs	https://doi.org/10.1016/j.artres.2014.07.004
Publication status	Published - 1 Dec 2014
Externally published	Yes

Keywords

antihypertensive agents
haemodynamics
hypertension
vascular stiffness

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10.1016/j.artres.2014.07.004

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title = "Value of haemodynamic profiling to the response of antihypertensive therapy",

abstract = "Background: Essential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients. Methods: In this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4mg, candesartan 16mg, bisoprolol 5mg, isosorbide mononitrate (ISMN) 50mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug. Results: Baseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7-28.9%) and high PPA (1.22-1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3-48.2%) and low PPA (1.05-1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. Conclusions: Our study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results. Clinical Trials Registry number: EudraCT 2006-006981-40.",

keywords = "antihypertensive agents, haemodynamics, hypertension, vascular stiffness",

author = "M. Serg and J. Graggaber and P. Kampus and M. Zagura and J. Kals and K. M{\"a}ki-Pet{\"a}j{\"a} and J. Cheriyan and M. Zilmer and J. Eha and McEniery, {C. M.} and Wilkinson, {I. B.}",

year = "2014",

month = dec,

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doi = "10.1016/j.artres.2014.07.004",

language = "English",

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journal = "Artery Research",

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TY - JOUR

T1 - Value of haemodynamic profiling to the response of antihypertensive therapy

AU - Serg, M.

AU - Graggaber, J.

AU - Kampus, P.

AU - Zagura, M.

AU - Kals, J.

AU - Mäki-Petäjä, K.

AU - Cheriyan, J.

AU - Zilmer, M.

AU - Eha, J.

AU - McEniery, C. M.

AU - Wilkinson, I. B.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background: Essential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients. Methods: In this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4mg, candesartan 16mg, bisoprolol 5mg, isosorbide mononitrate (ISMN) 50mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug. Results: Baseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7-28.9%) and high PPA (1.22-1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3-48.2%) and low PPA (1.05-1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. Conclusions: Our study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results. Clinical Trials Registry number: EudraCT 2006-006981-40.

AB - Background: Essential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients. Methods: In this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4mg, candesartan 16mg, bisoprolol 5mg, isosorbide mononitrate (ISMN) 50mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug. Results: Baseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7-28.9%) and high PPA (1.22-1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3-48.2%) and low PPA (1.05-1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. Conclusions: Our study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results. Clinical Trials Registry number: EudraCT 2006-006981-40.

KW - antihypertensive agents

KW - haemodynamics

KW - hypertension

KW - vascular stiffness

UR - http://www.scopus.com/inward/record.url?scp=85028104170&partnerID=8YFLogxK

U2 - 10.1016/j.artres.2014.07.004

DO - 10.1016/j.artres.2014.07.004

M3 - Article

AN - SCOPUS:85028104170

SN - 1872-9312

VL - 8

SP - 189

EP - 196

JO - Artery Research

JF - Artery Research

IS - 4

ER -

Value of haemodynamic profiling to the response of antihypertensive therapy

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Keywords

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