This Article Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.09.057v1 j.jacc.2005.09.057v2 47/4/794    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kokkinos, P. Articles by Singh, S. Search for Related Content PubMed PubMed Citation Articles by Kokkinos, P. Articles by Singh, S.

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]