Hypertension, Vol 14, 14-21, Copyright © 1989 by American Heart Association
R Kelly, J Daley, A Avolio and M O'Rourke
We compared dilevalol (an isomer of labetalol), 200-400 mg daily, against
atenolol, 50-100 mg daily, in a double-blind, crossover, placebo-controlled
trial with respect to effects on arterial distensibility (measured as pulse
wave velocity [PWV]) and wave reflection (assessed from carotid pressure
wave contour). Twelve patients of mean age 58 years (range 44-73 years)
with essential hypertension (supine diastolic blood pressure 95-114 mm Hg)
took active therapy for 12 weeks, separated by a 2-4 week placebo period.
Carotid pressure waveforms were recorded noninvasively by applanation
tonometry with a Millar micromanometer-tipped probe. PWV was measured
between carotid and femoral arteries (aortic PWV), carotid and radial
arteries (arm PWV), and femoral and pedal arteries (leg PWV). Early wave
reflection was calculated from the ratio of the height of the peak of the
carotid wave above its shoulder to the pulse pressure and was expressed as
an augmentation index. Both drugs were equally effective in reducing
brachial sphygmomanometric pressure and PWV in all three regions (active
vs. placebo, p less than 0.001), but there was no significant difference
between the two active therapies. However, the augmentation index (averaged
during the treatment period) was significantly lower with dilevalol (19%)
than with atenolol (28%, p less than 0.01), corresponding to a greater
decrease of 5-8 mm Hg in carotid systolic pressure compared with the
brachial artery. Although both drugs were equally effective in reducing
arterial distensibility, the vasodilating action of dilevalol gave added
benefit in reducing wave reflection, presumably through its vasodilatory
effect on peripheral conduit arteries.
ARTICLES
Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension
Medical Professorial Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia.
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