Re: Beta-Blockade Mitigates Exercise Blood Pressure in Hypertensive Male Patients

On Aug 31, 5:49 pm, bigvince <Vince.Mirag...@xxxxxxxxx> wrote:
On Aug 31, 5:42 pm, MarilynMann <ma...@xxxxxxxxxxx> wrote:





On Aug 31, 5:07 pm, Susan <neverm...@xxxxxxxxxx> wrote:

x-no-archive: yes

MarilynMann wrote:

His coronary artery calcium score was 488, which is in the 94th
percentile for a man his age. Plus there is a family history of early
heart attacks. The exercise-induced hypertension may be an issue
because his SBP went up to 218 during the stress test.

Didn't you say there's also a family habit of eating in the most
atherogenic way possible? Trying to prevent that kind of heart disease
without radical dietary changes is offering false assurances.

I'm not trying to antagonize, I guess I'm kind of shocked that with all
the homework and discussion done here that you're resting your hopes on
those drugs.

Susan

I don't know enough about beta-blockers to have an opinion on them.
Statins lower CVD events and mortality, so a statin seems like a
reasonable choice here.

His diet is significantly better than what he was brought up with.

Here a recent study

: Pharmacotherapy. 2007 Sep;27(9):1322-33. Links
Discordant Effects of beta-Blockade on Central Aortic Systolic and
Brachial Systolic Blood Pressure: Considerations Beyond the
Cuff.Epstein BJ, Anderson S.
1 Department of Pharmacy Practice, College of Pharmacy, University of
Florida, Gainesville, Florida; Division of Internal Medicine, College
of Medicine, University of Florida, Gainesville, Florida.
The role of beta-blockers in uncomplicated hypertension has been
challenged recently. Compared with other antihypertensives, beta-
blockers are less effective for preventing cardiovascular events in
patients with uncomplicated hypertension. Moreover, a recent meta-
analysis of placebo-controlled clinical trials concluded that
atenolol
is not more efficacious than placebo for preventing cardiovascular
events in patients with hypertension. Although these agents lower
blood pressure measured conventionally over the brachial artery with
a
blood pressure cuff, they do not exert a commensurate effect on blood
pressure in the central aorta. Central aortic blood pressure and
aortic augmentation index are strong predictors of left ventricular
hypertrophy, an independent risk factor for cardiovascular events.
Emerging data are illuminating the antihypertensive paradox whereby
antihypertensive agents may elicit discordant effects on central and
peripheral blood pressure and hemodynamics. Vasodilatory
antihypertensives, such as renin-angiotensin-aldosterone system
inhibitors and calcium channel blockers, elicit reductions in central
aortic blood pressure equal to or greater than that in the brachial
artery. Conversely, beta-blockers lower central aortic blood pressure
to a lesser degree even when blood pressure measured by
sphygmomanometry is reduced substantially. Given the strong
relationship between central aortic blood pressure and target organ
damage, the effectiveness of beta-blockers may be overestimated in
practice on the basis of conventional blood pressure measurements
alone. Differences in central and peripheral blood pressure may
account for the lack of cardiovascular protection afforded by beta-
blockers in clinical trials and could account for a portion of the
apparent "benefit beyond blood pressure" reduction with other classes
of antihypertensive agents. Future studies should aim to better
clarify the role of central aortic blood pressure in the treatment of
hypertension. In the meantime, the effects of antihypertensive drugs
on blood pressure "beyond the brachial blood pressure cuff" should be
considered when prescribing antihypertensive agents for a patient.

PMID: 17723086 [PubMed - in process]

Thanks Vince- Hide quoted text -

- Show quoted text -

Vince,

My husband does not have hypertension under ordinary circumstances,
only during intense exercise. Apparently there is some evidence that
beta-blockers are good for exercise-induced hypertension. I have just
started to look at this, so I really haven't formed an opinion yet.

Marilyn

.

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