Abstract 3844: Deleterious Effects of Beta-blockers on Arterial Stiffness and Central Pulse Pressure In Postmenopausal Women: Baseline Findings From The Cashmere Trial
Background and objectives: Beta-blockers (BB) may be less effective than other antihypertensive drugs for stroke prevention in patients with primary hypertension (ASCOT and LIFE studies). Our study compares arterial stiffness and central PP between users (BB+) and non users of BB (BB-), among menopausal women with hypercholesterolemia and no history of CV disease.
Design and methods: We used the baseline data of 664 menopausal women, screened for the Cashmere study, a double-blind randomized trial comparing the effects of 12-month therapy with atorvastatin (80 mg/day), versus placebo, associated or not with hormone therapy , on the progression of CCA-IMT and arterial stiffness. Aortic stiffness was measured by carotid-femoral pulse wave velocity (PWV); central PP and augmentation index (AI, wave reflection) were determined by applanation tonometry; carotid stiffness was calculated from relative stroke change in diameter (echotracking system) and carotid PP. BB were used in 104 women for treating headache, tachycardia, arrhythmia, and hypertension. 97% BB used were devoid of vasodilating properties.
Results: Age (60 ± 6 vs 58 ± 5 yrs, P < 0.0001) and mean BP (MBP: 91 ± 12 vs 88 ± 11 mmHg, P < 0.0001) were slightly but significantly higher in BB+ than in BB- (n = 560). After adjustment to age and MBP, BB+ had 10% higher central PP (P < 0.0001), 6% higher AI (P < 0.001), 4% higher PWV (P = 0.04), and 5% higher carotid stiffness (P < 0.01) than BB−. BB+ had 4% higher central SBP (P < 0.0001) than BB−, despite a non significantly higher brachial SBP only (1%, P = NS). To rule out an influence of hypertension on arterial parameters, we compared users of anti-hypertensive drugs (n = 110) to non users (n = 554). No significant difference was observed concerning the above parameters, excluding or not BB-users.
Conclusions: In menopausal women with hypercholesterolemia and no history of CV disease, the use of non vasodilating BB was associated with higher aortic and carotid stiffness, central PP, and wave reflection, independently of age and mean BP. These data are consistent with the results of the CAFÉ study. Whether the deleterious effects of BB on large arteries increase the risk of CV events in this population remains to be determined.