The fixed combination of amlodipine and bisoprolol eliminates the effect of β-blockers on central pulse wave in patients with arterial hypertension
Aim: to assess effect of β-blockers in the characteristics of the central pulse wave and the effect of switching to a fixed bisoprolol/ amlodipine (B/A) combination. Material and methods. Untreated patients (n = 28, age 53.6 ±5.7 years, 19 men) with uncomplicated hypertension without diabetes were given bisoprolol 5-10 mg. After 4 weeks at blood pressure (BP) >40/90 mmHg amlodipine (5 mg) was added by switching to a fixed B/A combination. The dose of amlodipine in this combination was increased to 10 mg in order to achieve target BP. The duration of combination therapy was 8 weeks. Analysis of the contour of central pulse wave and measurement of pulse wave velocity between carotid and femoral arteries (PWVCA) were evaluated before treatment, after monotherapy with bisoprolol, and after therapy with fixed B/A combination. Results. After monotherapy with bisoprolol 5 patients achieved BP control, 23 were switched to a fixed B/A combination. Monotherapy with bisoprolol reduced mainly peripheral BP and increased augmentation index (Al) of aortic pulse pressure, normalized to heart rate of 75 beats/min (AI-75). Switching to a fixed B/A combination resulted in further reduction of peripheral BP and significantly greater lowering of central systolic and pulse pressure, return of AI-75 to baseline values, significant decrease of PWVCA. Conclusion. Switching to a fixed B/A combination eliminates the potentially undesirable effects of β-blockers on the parameters of the reflected wave, thus resulting in effective lowering of central systolic and pulse BP, and reduction of PWVCA.