A prospective, randomized, open-label, active-controlled, clinical trial to assess central haemodynamic effects of bisoprolol and atenolol in hypertensive patients

Abstract

OBJECTIVE: The results from the ASCOT CAFÉ study demonstrated the inferiority of beta blockers in reducing central aortic blood pressure. In this study, we wanted to demonstrate whether or not second-generation beta blockers with higher beta 1 selectivity, namely bisoprolol, may counterbalance the effect of bradycardia through reduced reflection wave magnitude resulting from the relative lack of increase in peripheral vascular resistance. METHOD: This was a prospective, randomized, open-label, active-controlled trial in 209 hypertensive patients to evaluate the effect of bisoprolol and atenolol on aortic pulse pressure. Patients received a once-daily 5 mg dose of bisoprolol (n = 96) or 50 mg dose of atenolol (n = 95) at baseline with titration up to bisprolol 10 mg and atenolol 100 mg allowed at the 4th week when the brachial blood pressure was above treatment goal (average dose: bisoprolol: 5.4 mg, atenolol: 52.8 mg). Central blood pressure and augmentation index were measured at baseline and 12 weeks later, by pulse wave analysis with radial artery tonometry. The primary endpoint of the study was the difference in the central pulse pressure (CPP) at 12 weeks. RESULTS: The results showed a significant reduction of CPP in both groups at week 12 of administration compared with the predose level (P < 0.05); however, there was no significant difference in terms of CPP change [bisoprolol (baseline CPP 47.49 ± 11.33, follow-up 43.09 ± 11.67) vs. atenolol (baseline CPP 45.93 ± 11.62, follow-up 42.23 ± 9.92), P = 0.594]. CONCLUSION: In this study, there was no significant difference between bisoprolol and atenolol in terms of reduction of aortic pulse pressure after 12 weeks of treatment.