Document Detail

Discordant beta-blocker effects on clinic, ambulatory, resting, and exercise hemodynamics in patients with hypertension.
MedLine Citation:
PMID:  16945046     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: To determine the correlation between ambulatory and clinic blood pressure in assessing antihypertensive response to beta-blockade, to test whether blood pressure response to metoprolol is associated with the heart rate response, and to determine whether exercise and resting heart rate responses to metoprolol are correlated. DESIGN: Post hoc analysis of a prospective cohort study. SETTING: University-affiliated general clinical research center. PATIENTS: Fifty-one patients aged 35-65 years with uncomplicated hypertension. Intervention. All patients received metoprolol at a dosage titrated to achieve a diastolic blood pressure below 90 mm Hg. MEASUREMENTS AND MAIN RESULTS: Clinic and 24-hour ambulatory blood pressure measurements were obtained and exercise treadmill testing was performed before and after metoprolol treatment. Based on ambulatory blood pressure data, 24 patients (47%) responded (defined as at least a 10% reduction in diastolic blood pressure) to metoprolol compared with 36 patients (71%) based on clinic blood pressure data (p=0.027). Clinic blood pressure was associated with a 67% false-positive rate (responsive blood pressure by clinic data that was actually nonresponsive by ambulatory data). Blood pressure responders and nonresponders exhibited similar reductions in exercise heart rate (24% and 23%, p=0.74). However, responses to metoprolol measured by exercise heart rate versus resting heart rate were not significantly correlated (r=0.24, p=0.105). CONCLUSION: Reliance on clinic blood pressure or resting heart rate for making beta-blocker treatment decisions may yield less than optimal assessment of the antihypertensive response or degree of beta-blockade.
Amber L Beitelshees; Issam Zineh; Hossein N Yarandi; Daniel F Pauly; Julie A Johnson
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pharmacotherapy     Volume:  26     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-01     Completed Date:  2007-01-10     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1247-54     Citation Subset:  IM    
Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, Florida 32610-0486, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Ambulatory Care Facilities
Antihypertensive Agents / therapeutic use*
Blood Pressure
Exercise / physiology
Heart Rate
Hypertension / drug therapy*,  physiopathology
Metoprolol / therapeutic use*
Middle Aged
Grant Support
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 37350-58-6/Metoprolol

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