(Hypertension. 1995;25:1034-1041.)
© 1995 American Heart Association, Inc.
Articles |
Different Effects of Fosinopril and Atenolol on Wave Reflections in Hypertensive Patients
From the Division of Cardiology, Veterans General Hospital-Taipei (C.-H.C., S.-J.L., T.-L.H., S.-P.W., M.-S.C.); the Veterans General Hospital-Taichung (C.-T.T.), Republic of China; the Division of Cardiology, Johns Hopkins Hospital, Baltimore, Md (F.C.P.Y., C.O.S.); and the Institute of Public Health, National Yang-Ming University, Taipei (P.C.), Republic of China.
Correspondence to Chen-Huan Chen, MD, Division of Cardiology, Department of Medicine, Veterans General Hospital-Taipei, Shih-Pai, Taipei, Taiwan, 11217, ROC.
Abstract We conducted this study to compare the effects of
fosinopril versus atenolol on peripheral blood pressure, central
arterial wave reflection, and left ventricular mass in a group of
patients with essential hypertension. We conducted a double-blind,
randomized trial of fosinopril and atenolol in 79 hypertensive patients
(52 men, 27 women; mean age, 45.8±8.5 years; range, 30 to 68 years).
Carotid pressure waveforms were recorded noninvasively by applanation
tonometry with a Millar micromanometer-tipped probe. The extent of wave
reflection was estimated by the augmentation index defined as the ratio
of the amplitude of pressure wave above its systolic shoulder to the
pulse pressure. The augmentation index, left ventricular mass index by
two-dimensional echocardiography, and 24-hour ambulatory blood
pressures were determined before and after 8 weeks of daily treatment
with fosinopril (10 to 20 mg) or atenolol (50 to 100 mg) with or
without diuretics and compared with those values in 79 normotensive
control subjects. After 8 weeks of treatment, both drugs lowered
24-hour ambulatory peripheral systolic and diastolic pressures into the
normal range to a similar extent (fosinopril, -18/-13 mm Hg;
atenolol, -23/-17 mm Hg, both P=NS). On the other hand,
whereas the elevated augmentation index in hypertensive patients
compared with normotensive subjects (16±11% versus 10±8%) was
completely normalized by fosinopril (-9.3±9.8%, P
.002),
it was lowered by atenolol (-4.8±8.9%, P<.002) but to a
significantly smaller extent (fosinopril versus atenolol effect,
P=.04). Neither drug affected the slightly elevated left
ventricular mass index (fosinopril, 93±13 gm/m2; atenolol,
98±20 gm/m2) compared with normotensive subjects (86±13
gm/m2). At the doses used, fosinopril and atenolol reduced
peripheral blood pressure similarly but had different effects on
central systolic wave reflections, implying a greater effect of
fosinopril than atenolol in reducing central blood pressure than is
apparent from measurements of peripheral pressure. Left ventricular
mass was only slightly elevated in these mild hypertensive patients and
was not altered after 8 weeks of treatment.
Key Words: hypertension, essential • tonometry • fosinopril • atenolol
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