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CLINICAL RESEARCH: SYSTEMIC AND PULMONARY HYPERTENSION

Beta-Blockade Mitigates Exercise Blood Pressure in Hypertensive Male Patients

Cardiology Division, Veterans Affairs and Georgetown University Medical Centers, Washington, DC.

Manuscript received July 5, 2005; revised manuscript received August 31, 2005, accepted September 19, 2005.

^_* Reprint requests and correspondence: Dr. Peter Kokkinos, Cardiology Division, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422. (Email: peter.kokkinos{at}med.va.gov).

OBJECTIVES: The purpose of this study was to determine the antihypertensive agent(s) more likely to mitigate an exaggerated rise in exercise blood pressure (BP) in hypertensive patients.

BACKGROUND: An exaggerated rise in exercise BP is associated with increased cardiovascular risk. There are no recommendations for treating such response.

METHODS: Participants were hypertensive men (n = 2,318; age 60 ± 10 years), undergoing a routine exercise test at the Veterans Affairs Medical Center, Washington, DC. Antihypertensive therapy included angiotensin-converting enzyme inhibitors (n = 437), calcium-channel blockers (n = 223), diuretics (n = 226), and combinations (n = 1,442), beta-blockers alone (n = 201) or in combination with other antihypertensive agents (n = 467), and none (n = 208). Exercise BP, heart rate (HR) and rate-pressure product (RPP) at maximal and submaximal workloads were assessed.

RESULTS: After adjusting for covariates, patients treated with beta-blockers or beta-blocker–based therapy had significantly lower BP, HR, and RPP at 5 and 7 metabolic equivalents (METs) and peak exercise than those treated with any other antihypertensive agent or combination (p < 0.05). The likelihood of achieving an exercise systolic BP of 210 mm Hg was 68% lower (odds ratio = 0.32, 96% confidence interval 0.2 to 0.53) in the beta-blocker–based therapy versus other medications. African Americans exhibited higher BP and HR than Caucasians at all exercise workloads regardless of antihypertensive therapy and had over a 90% higher likelihood for an abnormal exercise BP response. This risk was attenuated by 35% with a beta-blocker–based therapy.

CONCLUSIONS: Significantly lower exercise BP, HR, and RPP levels are achieved with beta-blocker–based therapy than with other antihypertensive agents regardless of race. However, BP was better controlled in Caucasians than in African Americans regardless of antihypertensive therapy.

Abbreviations and Acronyms   ACE-I = angiotensin-converting enzyme inhibitors   BMI = body mass index   BP = blood pressure   CCB = calcium-channel blockers   CHD = coronary heart disease   CI = confidence interval   ETT = exercise tolerance test   HR = heart rate   METs = metabolic equivalents   OR = odds ratio   RPP = rate pressure product

This article has been cited by other articles:

				P. F. Kokkinos, S. Singh, and P. Narayan Reply J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1285 - 1285. [Full Text] [PDF]

				S. Bangalore and F. H. Messerli Beta-Blockers and Exercise J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1284 - 1285. [Full Text] [PDF]