Effect of B blockade on haemodynamics and brain natriuretic peptide (BNP)

The aim of the study is to test the effects of Atenolol, Pindolol and Nebivolol on central blood pressure and augmentation index. Studies of normotensive and hypertensive individuals have confirmed that pulse pressure is a better predictor of cardiovascular events than mean pressure in older adults.

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There is evidence that the traditional beta blocker Atenolol is less effective in reducing strokes and also lowering central blood pressure and augmentation index. This may be due to a direct arterial stiffening effect but also partly due to a fall in heart rate. However, Nebivolol is much more beta 1 selective than Atenolol and also causes vasodilatation by releasing NO which may in turn have additional benefits with regard to augmentation index and central blood pressure.At visit 1 there will be a physical examination, blood pressure measurements, blood tests and measurements of arterial stiffness using a small sensor placed in turn against the skin on the arm and neck. The patients will be asked about their general medical history to ensure that it is safe for them to take part in the study. Patients will be randomised prior to commencement. Patients will them be given a single dose of either Atenolol 50 mg, Nebivolol 5 mg, Pindolol 5 mg, a placebo. Repeat measurements will be taken after 1, 2 and 4 h.Patients will return 1 week later for visit 2 when repeat measurements as for visit 1 will be performed and different medication given. As at visit 1 measurements will be taken after 1, 2 and 4 h.Patients will then be asked to return for visits 3 and 4 after an interval of 1 week between each visit. All measurements as for visit 1 and 2 will be repeated and randomised medication given.Each visit will last for approximately 5 h.

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