Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes
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- Bryan Williams
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- Peter S. Lacy
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- Simon M. Thom
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- Kennedy Cruickshank
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- Alice Stanton
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- David Collier
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- Alun D. Hughes
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- H. Thurston
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
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- Michael O’Rourke
- From the University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); National Heart & Lung Institute, International Center for Circulatory Health at St Mary’s Hospital, Imperial College London W2 ILA, London, UK (S.M.T., A.D.H.); Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (K.C.); Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin,...
Bibliographic Information
- Other Title
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- Principal Results of the Conduit Artery Function Evaluation (CAFE) Study
Abstract
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Different blood pressure (BP)–lowering drugs could have different effects on central aortic pressures and thus cardiovascular outcome despite similar effects on brachial BP. The Conduit Artery Function Evaluation (CAFE) study, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), examined the impact of 2 different BP lowering-regimens (atenolol±thiazide-based versus amlodipine±perindopril-based therapy) on derived central aortic pressures and hemodynamics. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> The CAFE study recruited 2199 patients in 5 ASCOT centers. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressures and hemodynamic indexes on repeated visits for up to 4 years. Most patients received combination therapy throughout the study. Despite similar brachial systolic BPs between treatment groups (Δ0.7 mm Hg; 95% CI, −0.4 to 1.7; <jats:italic>P</jats:italic> =0.2), there were substantial reductions in central aortic pressures with the amlodipine regimen (central aortic systolic BP, Δ4.3 mm Hg; 95% CI, 3.3 to 5.4; <jats:italic>P</jats:italic> <0.0001; central aortic pulse pressure, Δ3.0 mm Hg; 95% CI, 2.1 to 3.9; <jats:italic>P</jats:italic> <0.0001). Cox proportional-hazards modeling showed that central pulse pressure was significantly associated with a post hoc–defined composite outcome of total cardiovascular events/procedures and development of renal impairment in the CAFE cohort (unadjusted, <jats:italic>P</jats:italic> <0.0001; adjusted for baseline variables, <jats:italic>P</jats:italic> <0.05). </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> BP-lowering drugs can have substantially different effects on central aortic pressures and hemodynamics despite a similar impact on brachial BP. Moreover, central aortic pulse pressure may be a determinant of clinical outcomes, and differences in central aortic pressures may be a potential mechanism to explain the different clinical outcomes between the 2 BP treatment arms in ASCOT. </jats:p>
Journal
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- Circulation
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Circulation 113 (9), 1213-1225, 2006-03-07
Ovid Technologies (Wolters Kluwer Health)
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Details 詳細情報について
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- CRID
- 1361981469258523008
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- NII Article ID
- 30022671627
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- ISSN
- 15244539
- 00097322
- http://id.crossref.org/issn/00097322
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- Data Source
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- Crossref
- CiNii Articles