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

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Volume 8, Issue 4, December 2014, Pages 189 - 196

Value of haemodynamic profiling to the response of antihypertensive therapy

Authors

M. Serg^a^{, b}^{, *}^{, 1}, J. Graggaber^c^{, 1}, P. Kampus^a^{, b}, M. Zagura^a^{, b}, J. Kals^b^{, d}, K. Mäki-Petäjä^c, J. Cheriyan^c, M. Zilmer^b, J. Eha^a^{, e}, C.M. McEniery^c, I.B. Wilkinson^c

^aDepartment of Cardiology, University of Tartu, Tartu, Estonia

^bInstitute of Biomedicine and Translational Medicine, Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia

^cClinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom

^dClinic of Vascular Surgery, Tartu University Hospital, Tartu, Estonia

^eHeart Clinic, Tartu University Hospital, Tartu, Estonia

¹

Equal contributors.

^*Corresponding author. Department of Cardiology, University of Tartu, 8 Puusepa Street, 51014 Tartu, Estonia. Tel.: +372 7318455. E-mail address: martin.serg@ut.ee (M.Serg).

Corresponding Author

M. Serg

Received 5 March 2014, Revised 1 May 2014, Accepted 30 July 2014, Available Online 22 September 2014.

DOI: 10.1016/j.artres.2014.07.004 How to use a DOI?
Keywords: Antihypertensive agents; Hypertension; Vascular stiffness; Haemodynamics
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 4 mg, candesartan 16 mg, bisoprolol 5 mg, isosorbide mononitrate (ISMN) 50 mg, 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.
Open Access: This is an open access article distributed under the CC BY-NC license.

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Journal: Artery Research
Volume-Issue: 8 - 4
Pages: 189 - 196
Publication Date: 2014/09/22
ISSN (Online): 1876-4401
ISSN (Print): 1872-9312
DOI: 10.1016/j.artres.2014.07.004 How to use a DOI?
Open Access: This is an open access article distributed under the CC BY-NC license.

Cite this article

ris enw bib

TY  - JOUR
AU  - M. Serg
AU  - J. Graggaber
AU  - P. Kampus
AU  - M. Zagura
AU  - J. Kals
AU  - K. Mäki-Petäjä
AU  - J. Cheriyan
AU  - M. Zilmer
AU  - J. Eha
AU  - C.M. McEniery
AU  - I.B. Wilkinson
PY  - 2014
DA  - 2014/09/22
TI  - Value of haemodynamic profiling to the response of antihypertensive therapy
JO  - Artery Research
SP  - 189
EP  - 196
VL  - 8
IS  - 4
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2014.07.004
DO  - 10.1016/j.artres.2014.07.004
ID  - Serg2014
ER  -

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