Different Effects of Fosinopril and Atenolol on Wave Reflections in Hypertensive Patients

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/m 2 ; atenolol, 98±20 gm/m 2 ) compared with normotensive subjects (86±13 gm/m 2 ). 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.