Find in Library

Objective: Treatment with beta-blockers is characterised by inferior reduction of central versus peripheral blood pressure. We examined changes in central and peripheral blood pressure, cardiac function, and vascular resistance during beta-blockade. Methods: Haemodynamics were investigated after 3 weeks of bisoprolol treatment (5 mg/d) in a double-blinded, randomized, placebo-controlled cross-over trial in never-treated 16 Caucasian males with grade I-II primary hypertension using continuous tonometric pulse wave analysis and whole-body impedance cardiography. Results: Bisoprolol decreased blood pressure in the aorta (∼8/10 mmHg) and radial artery (∼10/9 mmHg), reduced heart rate and left cardiac work, and increased subendocardial viability index in supine and upright positions (p < 0.01 for all). Stroke volume was increased in the supine (∼11 ml, p < 0.01) but not in the upright position, while upright (∼1 l/min, p < 0.01) but not supine cardiac output was significantly reduced. Upright increase in systemic vascular resistance was amplified after bisoprolol (p < 0.05). Pulse pressure amplification was reduced especially in the upright position (supine reduction 10%, upright reduction 20%). Aortic augmentation index, augmentation pressure and pulse pressure were not changed in the supine position, but were increased in the upright position (from 7 to 20%, 3 to 7 mmHg, 28 to 35 mmHg, respectively, p < 0.01 for all). Conclusions: Bisoprolol decreased central and peripheral blood pressure in male subjects with grade I to grade II hypertension, but central blood pressure was reduced less efficiently than peripheral blood pressure. Importantly, the harmful influences of bisoprolol on central pulse pressure and pressure wave reflection were especially observed in the upright position.