PS 14-59 LEFT VENTRICULAR-ARTERIAL COUPLING CHANGES DURING TREATMENT WITH BISOPROLOL MONOTHERAPY AND BISOPROLOL/AMLODIPINE FIXED DOSE COMBINATION

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Abstract

Objective:

To evaluate ventricular-arterial coupling in hypertensive patients after therapy with a beta-blocker and its fixed dose combination (FDC) with amlodipine.

Design and Method:

Methods: 28 patients (age 53.95 ± 7.2, 20 males, BP 148.7 ± 13.4/96.6 ± 14.1 mmHg, HR 83.2 ± 10.1 bpm) with untreated uncomplicated hypertension underwent simultaneous EchoCG and blood pressure (BP) acquisition at baseline, after 4 weeks of bisoprolol 5–10 mg monotherapy and after 8 weeks after switching to FDC bisoprolol 5–10/amlodipine 5–10 mg. Doses were titrated to reach BP <140/90 mmHg. Arterial elastance (Ea) and LV elastance (Ees) at rest were calculated as end-systolic pressure (ESP)/stroke volume (SV) and ESP/end-systolic volume (ESV). Ventricular-arterial coupling (VAC) was assessed as Ea/Ees. Mechanical efficiency of left ventricle (ELV) and peripheral arterial resistance (PAR) were evaluated also. p < 0.05 was considered significant.

Results:

After monotherapy with bisoprolol BP was 146,1 ± 15,3/85,3 ± 11,3 mmHg (p > 0,05 vs baseline), HR 59,8 ± 7,7 (p < 0,05 vs baseline), after FDC 132,1 ± 11,3/76,23 ± 11,1 mmHg and 64,54 ± 7,0 bpm, respectively (all p < 0,05 vs baseline). Bisoprolol decreased Ees from 4,45 ± 1,9 to 3,67 ± 0,98 (p < 0,05) whereas Ea, PAR did not change significantly. Ea/Ees increased significantly from 0,47 ± 0,16 to 0,55 ± 0,14 (p < 0,05). Switching to bisoprolol/amlodipine FDC resulted in decrease of Ea from 1,88 ± 0,39 at baseline and from 1,92 ± 0,38 after bisoprolol monotherapy, PAR from 137,1 ± 35,3 at baseline and from 128,9 ± 36, respectively to 105,6 ± 28. Ees did not change from that on bisoprolol, Ea/Ees (0,45 ± 0,1) returned to baseline values. ELV did not change significantly throughout a study.

Conclusions:

In hypertensive patients monotherapy with bisoprolol reduces initially increased Ees without negative effect on Ea and PAR and switching to bisoprolol/amlodipine FDC results in additional Ea reduction. Thus the study confirms potential benefits of bisoprolol/amlodipine in arterial hypertension in terms of cardiovascular functioning.

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