Embed Size (px)
Citation preview
“ Heart rate reduction with beta-blockers is a major mechanismaccounting for less effective centralaortic pressure reduction per unitchange in brachial pressure, i.e. thepseudo-antihypertensive effect ofbeta-blockers.
Rimoldi et al Hypertension in press 2016
Methods:
A total of 46 patients with stable CAD wererandomly allocated to placebo (n=23) orivabradine (n=23) in a single-blinded fashionfor 6 months.Central BP and stroke volume weremeasured directly by left heartcatheterization at baseline and after 6months.
Rimoldi et al Hypertension in press 2016
Effect of Ivabradine on Central Pressure
Rimoldi et al Hypertension in press 2016
Effect of Ivabradine on Central Pressure
Rimoldi et al Hypertension in press 2016
Rimoldi et al Hypertension in press 2016
Effect of Ivabradine on Central Pressure
The slower the heart rate the higher central pressure
When Increase in Central Pressure OverridesBenefits of Heart Rate Lowering
Messerli et al. JACC in press 2016
HeartRate
% changefrom
Baseline
Messerli et al. JACC in press 2016
Effect of Ivabradine on Central Pressure,Heart Rate and Double Product
CentralPressure
HeartRate
DoubleProduct
% changefrom
Baseline
Messerli et al. JACC in press 2016
Effect of Ivabradine on Central Pressure,Heart Rate and Double Product
Messerli et al. JACC in press 2016
Effect of Cardiovascular Drugs on Central Pressure
Messerli et al. JACC in press 2016
Effect of Cardiovascular Drugs on Central Pressure
Messerli et al. JACC in press 2016
Effect of Cardiovascular Drugs on Central Pressure
Messerli et al. JACC in press 2016
Winnie Langleydied August 12,2010, age 103after havingsmoked for morethan 95 years,HTN since her40ties…lungcancer at 87.
Winnie Langleydied August 12,2010, age 103after havingsmoked for morethan 95 years,HTN since her40ties…lungcancer at 87.
SleepAwake
mmHg
November 08. 2016
SleepAwake
Snortingcocaine
mmHg
SleepAwake
Snortingcocaine
Smokingpot
mmHg
Messerli and Hofstetter, NEJM
Muntner et al. Annals of Internal Medicine • 163 ,1 September 2015
Standard Deviation of SBP
ALLHAT
Bangalore et al. JACC
High LDLV& BPV
Bangalore et al. 2017
Bangalore et al. 2016, almost in press…
