Key result
ACE inhibitors and ARBs lower pulse wave velocity more effectively than other antihypertensives.
Why the study?
Do antihypertensive drugs reduce arterial stiffness and wave reflections in patients?
Do antihypertensive drugs reduce arterial stiffness and wave reflections in patients?
ACE inhibitors and ARBs may be superior to other antihypertensive classes for improving arterial stiffness, whereas beta-blockers are inferior for wave reflections, highlighting differing vascular effects beyond blood pressure lowering.
May support ACE inhibitor or ARB preference for arterial stiffness; leaves open outcome impact before practice change.
We reviewed trials that tested the efficacy of antihypertensive drugs in reducing arterial stiffness and wave reflections as assessed by pulse wave velocity and augmentation index, respectively. Regardless of cross-over or parallel-group comparison design, placebo-controlled trials demonstrated that antihypertensive drugs were effective in reducing pulse wave velocity. In actively-controlled parallel-group comparison studies, this effect on arterial stiffness was more evident for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers than other classes of antihypertensive drugs, particularly when brachial-ankle pulse wave velocity was measured. Regardless of cross-over or parallel-group comparison or placebo- or actively-controlled design, the reviewed trials showed that β-blockers were inferior to all the other classes of antihypertensive drugs in reducing augmentation index. However, these studies had a small sample size and a short follow-up time and did not link the changes in measurements of arterial function with cardiovascular events. Whether the superiority or inferiority is clinically relevant for cardiovascular protection and prevention remains to be investigated.
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Liu et al. (2013) conducted a review in Increased arterial stiffness and wave reflections. Antihypertensive drugs vs. Placebo or other classes of antihypertensive drugs was evaluated on Pulse wave velocity and augmentation index. Antihypertensive drugs effectively reduced pulse wave velocity, with ACE inhibitors and ARBs showing greater efficacy, while beta-blockers were inferior in reducing augmentation index.
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