Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure

Ryan John McNally; Andrii Boguslavskyi; Rayka Malek; Christopher N Floyd; Marina Cecelja; Abdel Douiri; Rosa-Maria Bruno; Bushra Farukh; Phil Chowienczyk; Luca Faconti

doi:10.1161/HYPERTENSIONAHA.123.22436

Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure

Ryan John McNally, Andrii Boguslavskyi, Rayka Malek, Christopher N Floyd, Marina Cecelja, Abdel Douiri, Rosa-Maria Bruno, Bushra Farukh, Phil Chowienczyk, Luca Faconti

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Increased arterial stiffness and pulse wave velocity (PWV) of the aorta and large arteries impose adverse hemodynamic effects on the heart and other organs. Antihypertensive treatment reduces PWV, but it is unknown whether this results from an unloading of stiffer elements in the arterial wall or is due to an alternate functional or structural change that might differ according to class of antihypertensive drug.

METHODS: We performed a systematic review and meta-analysis of the effects of different antihypertensive drug classes and duration of treatment on PWV with and without adjustment for change in mean arterial blood pressure (BP; study 1) and compared this to the change in PWV after an acute change in transmural pressure, simulating an acute change in BP (study 2).

RESULTS: A total of 83 studies involving 6200 subjects were identified. For all drug classes combined, the reduction of PWV was 0.65 (95% CI, 0.46-0.83) m/s per 10 mm Hg reduction in mean arterial BP, a change similar to that induced by an acute change in transmural pressure in a group of hypertensive subjects. When adjusted for change in mean arterial BP, the reduction in PWV after treatment with beta-blockers or diuretics was less than that after treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists or calcium channel antagonists.

CONCLUSIONS: Reduction in PWV after antihypertensive treatment is largely explained by the reduction in BP, but there are some BP-independent effects. These might increase over time and contribute to better outcomes over the long term, but this remains to be demonstrated in long-term clinical trials.

Original language	English
Pages (from-to)	1619-1627
Number of pages	9
Journal	Hypertension (Dallas, Tex. : 1979)
Volume	81
Issue number	7
Early online date	9 May 2024
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.123.22436
Publication status	Published - 1 Jul 2024

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10.1161/HYPERTENSIONAHA.123.22436

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McNally, R. J., Boguslavskyi, A., Malek, R., Floyd, C. N., Cecelja, M., Douiri, A., Bruno, R.-M., Farukh, B., Chowienczyk, P., & Faconti, L. (2024). Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure. Hypertension (Dallas, Tex. : 1979), 81(7), 1619-1627. https://doi.org/10.1161/HYPERTENSIONAHA.123.22436

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title = "Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure",

abstract = "BACKGROUND: Increased arterial stiffness and pulse wave velocity (PWV) of the aorta and large arteries impose adverse hemodynamic effects on the heart and other organs. Antihypertensive treatment reduces PWV, but it is unknown whether this results from an unloading of stiffer elements in the arterial wall or is due to an alternate functional or structural change that might differ according to class of antihypertensive drug.METHODS: We performed a systematic review and meta-analysis of the effects of different antihypertensive drug classes and duration of treatment on PWV with and without adjustment for change in mean arterial blood pressure (BP; study 1) and compared this to the change in PWV after an acute change in transmural pressure, simulating an acute change in BP (study 2).RESULTS: A total of 83 studies involving 6200 subjects were identified. For all drug classes combined, the reduction of PWV was 0.65 (95% CI, 0.46-0.83) m/s per 10 mm Hg reduction in mean arterial BP, a change similar to that induced by an acute change in transmural pressure in a group of hypertensive subjects. When adjusted for change in mean arterial BP, the reduction in PWV after treatment with beta-blockers or diuretics was less than that after treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists or calcium channel antagonists.CONCLUSIONS: Reduction in PWV after antihypertensive treatment is largely explained by the reduction in BP, but there are some BP-independent effects. These might increase over time and contribute to better outcomes over the long term, but this remains to be demonstrated in long-term clinical trials.",

author = "McNally, {Ryan John} and Andrii Boguslavskyi and Rayka Malek and Floyd, {Christopher N} and Marina Cecelja and Abdel Douiri and Rosa-Maria Bruno and Bushra Farukh and Phil Chowienczyk and Luca Faconti",

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doi = "10.1161/HYPERTENSIONAHA.123.22436",

language = "English",

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McNally, RJ, Boguslavskyi, A, Malek, R , Floyd, CN , Cecelja, M , Douiri, A, Bruno, R-M, Farukh, B , Chowienczyk, P & Faconti, L 2024, 'Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure', Hypertension (Dallas, Tex. : 1979), vol. 81, no. 7, pp. 1619-1627. https://doi.org/10.1161/HYPERTENSIONAHA.123.22436

Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure. / McNally, Ryan John; Boguslavskyi, Andrii; Malek, Rayka et al.
In: Hypertension (Dallas, Tex. : 1979), Vol. 81, No. 7, 01.07.2024, p. 1619-1627.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension

T2 - A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure

AU - McNally, Ryan John

AU - Boguslavskyi, Andrii

AU - Malek, Rayka

AU - Floyd, Christopher N

AU - Cecelja, Marina

AU - Douiri, Abdel

AU - Bruno, Rosa-Maria

AU - Farukh, Bushra

AU - Chowienczyk, Phil

AU - Faconti, Luca

PY - 2024/7/1

Y1 - 2024/7/1

N2 - BACKGROUND: Increased arterial stiffness and pulse wave velocity (PWV) of the aorta and large arteries impose adverse hemodynamic effects on the heart and other organs. Antihypertensive treatment reduces PWV, but it is unknown whether this results from an unloading of stiffer elements in the arterial wall or is due to an alternate functional or structural change that might differ according to class of antihypertensive drug.METHODS: We performed a systematic review and meta-analysis of the effects of different antihypertensive drug classes and duration of treatment on PWV with and without adjustment for change in mean arterial blood pressure (BP; study 1) and compared this to the change in PWV after an acute change in transmural pressure, simulating an acute change in BP (study 2).RESULTS: A total of 83 studies involving 6200 subjects were identified. For all drug classes combined, the reduction of PWV was 0.65 (95% CI, 0.46-0.83) m/s per 10 mm Hg reduction in mean arterial BP, a change similar to that induced by an acute change in transmural pressure in a group of hypertensive subjects. When adjusted for change in mean arterial BP, the reduction in PWV after treatment with beta-blockers or diuretics was less than that after treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists or calcium channel antagonists.CONCLUSIONS: Reduction in PWV after antihypertensive treatment is largely explained by the reduction in BP, but there are some BP-independent effects. These might increase over time and contribute to better outcomes over the long term, but this remains to be demonstrated in long-term clinical trials.

AB - BACKGROUND: Increased arterial stiffness and pulse wave velocity (PWV) of the aorta and large arteries impose adverse hemodynamic effects on the heart and other organs. Antihypertensive treatment reduces PWV, but it is unknown whether this results from an unloading of stiffer elements in the arterial wall or is due to an alternate functional or structural change that might differ according to class of antihypertensive drug.METHODS: We performed a systematic review and meta-analysis of the effects of different antihypertensive drug classes and duration of treatment on PWV with and without adjustment for change in mean arterial blood pressure (BP; study 1) and compared this to the change in PWV after an acute change in transmural pressure, simulating an acute change in BP (study 2).RESULTS: A total of 83 studies involving 6200 subjects were identified. For all drug classes combined, the reduction of PWV was 0.65 (95% CI, 0.46-0.83) m/s per 10 mm Hg reduction in mean arterial BP, a change similar to that induced by an acute change in transmural pressure in a group of hypertensive subjects. When adjusted for change in mean arterial BP, the reduction in PWV after treatment with beta-blockers or diuretics was less than that after treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists or calcium channel antagonists.CONCLUSIONS: Reduction in PWV after antihypertensive treatment is largely explained by the reduction in BP, but there are some BP-independent effects. These might increase over time and contribute to better outcomes over the long term, but this remains to be demonstrated in long-term clinical trials.

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DO - 10.1161/HYPERTENSIONAHA.123.22436

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JO - Hypertension (Dallas, Tex. : 1979)

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ER -

Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure

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