Heart rate dependent and independent effects of beta-blockers on central hemodynamic parameters: a propensity score analysis

J Hypertens. 2016 Aug;34(8):1535-43. doi: 10.1097/HJH.0000000000000978.


Objectives: Central hemodynamic parameters are better predictors of the cardiovascular burden than peripheral blood pressure (BP). Beta-blockers are known to reduce central BP to a lesser extent than peripheral BP, a hypothesized mechanistic consequence of heart rate (HR) reduction.

Methods: The association between beta-blocker use, HR and central hemodynamics indices was studied in treated hypertensive participants of the CARTaGENE study using propensity score analyses and multivariate linear regressions.

Results: Of the 20 004 participants, 2575 were treated hypertensive patients with valid pulse wave analysis. Using propensity score analyses, beta-blocker users (n = 605) were matched to nonusers having similar clinical characteristics with (Model 1) and without (Model 2) adjustment for HR. This resulted in 457 and 510 pairs with adequate balance, except for a HR difference in Model 2 (62.5 ± 10.5 vs. 70.4 ± 11.5 bpm, p < 0.001). In Model 1, the central pulse pressure (PP) was 46.5 ± 12.9 mmHg with beta-blocker compared with 45.4 ± 11.0 mmHg without (p = 0.045). PP amplification, augmentation index and augmented pressure were also less favorable with the use of beta-blocker. The HR difference in Model 2 further increased the difference in central PP observed with beta-blocker to 46.5 ± 13.0 vs. 43.3 ± 11.3 without (p < 0.001). These findings were similar when atenolol, metoprolol and bisoprolol were assessed separately using multivariate linear regression models.

Conclusion: This study shows that the unfavorable central hemodynamic profile of beta-blocker has both HR-dependent and HR-independent components that are similar for all frequently used β1-selective beta-blocker.

MeSH terms

  • Adrenergic beta-1 Receptor Antagonists / therapeutic use*
  • Aged
  • Atenolol / therapeutic use
  • Bisoprolol / therapeutic use
  • Blood Pressure / drug effects*
  • Cross-Sectional Studies
  • Female
  • Heart Rate / physiology*
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / physiopathology
  • Male
  • Metoprolol / pharmacology
  • Middle Aged
  • Propensity Score
  • Pulse Wave Analysis


  • Adrenergic beta-1 Receptor Antagonists
  • Atenolol
  • Metoprolol
  • Bisoprolol