Critical appraisal of the differential effects of antihypertensive agents on arterial stiffness

Figures & data

Figure 1 Schematic of arterial pressure waveforms and calculation of augmentation index (AIx).^3,4 A) Pulse waveforms in healthy compliant vasculature, timing of rebound wave reflection occurs during diastole (D). B) Pulse wave reflection is faster and earlier in stiffer arteries, thus amplifying the measured systolic BP peak (S), and reducing diastolic pressures (D), hence pulse pressure (PP) is increased (total height of combined pulse wave peak).

Abbreviation: AP, augmentation pressure.

Table 1 Effects of different antihypertensive agents on arterial stiffness

Class	Effect on Ao-PWV	Effect on central aortic pressures and AIx
Thiazide diuretics^Citation24	Neutral	Neutral
α-blockers
Doxazosin^Citation37,Citation38	Neutral	Neutral
β-blockers
Atenolol^Citation25,Citation28,Citation29	Reduce	Increase
Nebivolol,^Citation35 vasodilating	Reduce	Reduce
β-blocker
CCB^Citation23^Citation28^Citation32	Reduce	Reduce
RAAS blockers
Aldosterone antagonists^Citation32	Reduce	Reduce
ACE-I^Citation28,Citation33	Reduce	Reduce
ARB^Citation23,Citation29,Citation33	Reduce	Reduce

Abbreviations: ACE-I, ACE inhibitor; ARB, angiotensin receptor blocker; AIx, augmentation index; Ao-PWV, aortic pulse wave velocity; CCB, calcium channel blocker; RAAS, renin–angiotensin–aldosterone system.

Table 2 Effects of combination therapy of different classes of antihypertensive agents on arterial stiffness

Combination	Effect on Ao-PWV	Effect on central aortic pressures and AIx
ACE-I + CCB^Citation6	Neutral	Reduce
Thiazide + potassium-sparing (amiloride) diuretic^Citation26,Citation27	Neutral	Reduce
ACE-I + indapamide^Citation25	Reduce	Reduce
ARB + CCB^Citation24	Reduce	Reduce
ARB + thiazide diuretic^Citation23	Reduce	Reduce

Abbreviations: ACE-I, ACE inhibitor; ARB, angiotensin receptor blocker; AIx, augmentation index; Ao-PWV, aortic pulse wave velocity; CCB, calcium channel blocker.

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