Effect of atenolol on left ventricular function in hypertensive patients

Treatment considerations for the hypertensive patient over age 55

The prevalence of hypertension increases with age. The majority of the hypertensive population is over age 55. Although the treatment of systolic hypertension remains incompletely understood, the reduction of diastolic hypertension with pharmacotherapy has been shown to reduce complications from hypertension in persons over age 55. The older hypertensive patient is at risk for the same complications as the younger patient: angina, myocardial infarction, arteriosclerosis obliterans, stroke, myocardial hypertrophy, congestive heart failure, and renal failure; the risk of sudden death and multi-infarct dementia in the older patient may be somewhat higher. The older hypertensive individual may have reduced plasma volume and defective salt and water conservation, reduced renal function, impairment of baroreceptor reflexes and sympathetic reactivity, and altered drug pharmacokinetics, or may have arteriosclerosis leading to pseudohypertension. Many circumstances interfere with adequate compliance with therapeutic regimens among the elderly. Concomitant medical conditions increase the possibility of drug interactions and require that the practitioner be able to adjust the antihypertensive program to the patient.

Effects of dilevalol, metoprolol and atenolol on left ventricular mass and function in nonelderly and elderly hypertensive patients

Using serial M-mode echocardiographic determinations of left ventricular (LV) mass and function, the effects of dilevalol, a selective beta 2 agonist with nonselective beta-antagonist properties, were compared with those of metoprolol in 2 centers in double-blind, randomized clinical trials using similar protocols in nonelderly hypertensive patients (aged less than 65 years) (study 1). In a separate bicenter study with a similar design, dilevalol was compared with atenolol in elderly hypertensive patients (aged greater than or equal to 65 years) (study 2). Patients in both studies received placebo for 2 to 4 weeks, and were then randomized to receive increasing doses of dilevalol (200, 400, 800, 1,600 mg) or metoprolol (100, 200, 300, 400 mg) in study 1, and dilevalol (100, 200, 400, 800 mg) or atenolol (50, 100 mg) in study 2, to achieve a supine diastolic blood pressure (BP) of less than 90 mm Hg. In both studies, LV function and mass (Penn convention) were determined by echocardiographic examinations performed before randomization and at the end of the active treatment phase. Dilevalol, metoprolol and atenolol significantly reduced BP compared with placebo. In the nonelderly patients, a modest reduction in LV mass was observed with dilevalol (p less than 0.03) but not with metoprolol. Indexes of LV function--as assessed by end-diastolic and end-systolic dimensions, LV ejection time and ejection fraction--were better preserved by dilevalol than by metoprolol. In the elderly, neither dilevalol nor atenolol affected LV mass; however, indexes of LV function were better preserved with dilevalol than with atenolol.(ABSTRACT TRUNCATED AT 250 WORDS)

The hypertensive patient with concomitant cardiovascular disease

Many drugs for the treatment of hypertension are available in the United States today. Of the various factors that determine the appropriate treatment for a particular patient, the presence of concomitant heart disease requires specific tailoring of the antihypertensive therapy. Coronary artery disease, aortic insufficiency, congestive heart failure, left ventricular hypertrophy, premature ventricular contractions, supraventricular arrhythmias, mitral valve prolapse, orthostatic hypotension, and aortic dissection are some of the conditions that influence the choice of treatment. Diabetes places hypertensive patients at increased risk of heart disease, and exercise and sexual function are other considerations that govern the selection of treatment for the hypertensive person. For all of these conditions, more than one drug choice is often possible, but usually hypertensive patients can be treated with a beta-blocker or a calcium channel blocker in these special circumstances.

Changes in left ventricular mass during a double-blind study with chlorthalidone and slow-release nifedipine

The presence of a possible correlation between changes in left ventricular mass of hypertensive patients and the degree of blood pressure reduction with different antihypertensive drugs has been investigated in 40 outpatients by M-mode echocardiography. Ten of these, with blood pressure in normal limits with different antihypertensive treatment had their therapy changed in chlorthalidone 25 mg/day without any run-in (Group A); other 30 patients, with a previously uncontrolled blood pressure, after a 14 day run-in, were randomly allocated to chlorthalidone 25 mg/day (Group B), slow release nifedipine 20 mg/day (Group C) or placebo (Group D). At the end of the eight week treatment period a further decrease in systolic blood pressure was observed in Group A without changes in ventricular mass; an highly significant decrease in both systolic and diastolic blood pressure was observed in B and C but only patients on chlorthalidone changed their ventricular mass; no change in both blood pressure and ventricular mass was observed on placebo. As changes in ventricular mass are not correlated with blood pressure reduction, we conclude that other, not well defined factors, apart from the decrease in duration and degree of left ventricular systolic wall tension, may be responsible for reversal of left ventricular hypertrophy.

Noninvasive estimation of central aortic pressure using the oscillometric method for analyzing systemic artery pulsatile blood flow: comparative study of indirect systolic, diastolic, and mean brachial artery pressure with simultaneous direct ascending aortic pressure measurements

Brachial artery pressures determined by the oscillometric method were compared with simultaneous central aortic (Ao) pressure measurements in 30 patients undergoing cardiac catheterization. Three simultaneous oscillometric and central Ao pressure readings were obtained in each patient. Central Ao pressures ranged widely for systolic (SP) (98 to 177 mm Hg), diastolic (DP) (41 to 97 mm Hg), and mean (MP) (60 to 120 mm Hg) pressure values. The mean percent errors (pressure difference divided by central Ao pressure) and "within subject" standard deviation were 1% and 3% for SP, 2% and 4% for DP, and -3% and 7% for MP. The percent error in oscillometric SP and DP estimates was not significantly influenced by cardiac index, systemic vascular resistance, heart rate, body surface area, or left ventricular ejection fraction. The oscillometric method provides accurate, reproducible, and convenient estimates of central Ao SP and DP and may be particularly useful when indirect blood pressure measurements are required for the noninvasive assessment of left ventricular function in patients without aortic stenosis.