Hemodynamic and central blood pressure differences between carvedilol and valsartan added to lisinopril at rest and during exercise stress

• Published in: Journal of the American Society of Hypertension Vol. 6; no. 2; pp. 117 - 123
• Main Authors: Izzo, Joseph L., MD, Rajpal, Minesh, MBBS, Karan, Shaila, MBBS, Srikakarlapudi, Sirisha, MBBS, Osmond, Peter J., MS
• Format: Journal Article
• Language: English
• Published: United States 01.03.2012
• Subjects: Aged; Antihypertensive Agents - administration & dosage; Blood Pressure - drug effects; Blood Pressure - physiology; Carbazoles - administration & dosage; Cardiography, Impedance; Cardiovascular; Cross-Over Studies; Drug Therapy, Combination; Exercise - physiology; Female; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Lisinopril - administration & dosage; Male; Manometry; Middle Aged; Propanolamines - administration & dosage; Rest - physiology; Tetrazoles - administration & dosage; Valine - administration & dosage; Valine - analogs & derivatives; Valsartan; ambulatory blood pressure monitoring; clinical trial; antihypertensive drugs; Carvedilol; valsartan; cardiac work; hemodynamics
• ISSN: 1933-1711; 1878-7436
• DOI: 10.1016/j.jash.2011.12.001

Abstract There is little information about the hemodynamic and exercise-response implications of renin-angiotensin system blocker combinations. After a 3-week lisinopril (L; 40 mg/day) run-in, carvedilol (C; 20 then 40 mg/day) or valsartan (V; 160 then 320 mg/day) was added to L for 4 weeks each in a forced-titration, random order-entry crossover study in 30 subjects. Arterial tonometry (central pressures and time-tension index, TTI); impedance cardiography (steady-state hemodynamics), and ultrasound (carotid flow) were performed at rest and during supine bicycle exercise at 30 and 60 watts. At rest, both V and C lowered TTI similarly (7% to 9%, P = .05 compared with L, in part because they lowered blood pressure (3 to 7/3 to 4 mm Hg). V lowered central systolic pressure, augmentation pressure (AP), and systemic vascular resistance (SVR, all P < .02); C lowered heart rate but not central systolic pressure or SVR. During exercise, V persistently lowered central systolic pressure, AP, and SVR, whereas C did not. Neither drug affected exercise responses or carotid blood flow. Adding V or C to an angiotensin-converting enzyme inhibitor reduced cardiac workload by different mechanisms: vasodilation and reduced central blood pressure with V and lower heart rate with C.