Selective Heart Rate Reduction With Ivabradine Increases Central Blood Pressure in Stable Coronary Artery Disease

Rimoldi, Stefano F.; Messerli, Franz H.; Černý, Dávid; Gloekler, Steffen; Traupe, Tobias; Laurent, Stéphane; Seiler, Christian

doi:10.1161/hypertensionaha.116.07250

Cited by 36 publications

(24 citation statements)

References 31 publications

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“…A high value of SV due to the prolonged LV (left ventricle) filling time increases LV preload and higher values of systemic PP and central systolic pressure increase LV afterload. This indicates that lowering HR should be considered cautiously in patients, which supports previous conclusion (Rimoldi et al, 2016 ).…”

Section: Discussionsupporting

confidence: 90%

“…It has been documented that pharmacological HR lowering in patients with high BP can result in adverse cardiovascular outcomes (Rimoldi et al, 2016 ). Here, we showed significantly higher values of SV, systemic PP, and central systolic pressure at baseline as compared to HR of 135 and 155 bpm in swine.…”

Section: Discussionmentioning

confidence: 99%

“…Although multiple clinical studies have shown a direct relationship between BP levels and the risk of AF, the form of the relationship remains unknown (Conen et al, 2009 ; Grundvold et al, 2012 ; Verdecchia et al, 2012a , b ). Patients with high BP, however, do not benefit from the pharmacological heart rate (HR) lowering (Rimoldi et al, 2016 ). It is also unclear whether the pharmacological BP control can relieve the incidence and progression of AF (Manolis et al, 2012 ; Verdecchia et al, 2016 ; Whelton et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Acute Tachycardia Increases Aortic Distensibility, but Reduces Total Arterial Compliance Up to a Moderate Heart Rate

2018

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Background: The differential effects of rapid cardiac pacing on small and large vessels have not been well-established. The objective of this study was to investigate the effect of pacing-induced acute tachycardia on hemodynamics and arterial stiffness.Methods: The pressure and flow waves in ascending aorta and femoral artery of six domestic swine were recorded simultaneously at baseline and heart rates (HR) of 135 and 155 beats per minutes (bpm) and analyzed by the models of Windkessel and Womersley types. Accordingly, the flow waves were simultaneously measured at carotid and femoral arteries to quantify aortic pulse wave velocity (PWV). The arterial distensibility was identified in small branches of coronary, carotid and femoral arteries with diameters of 300–600 μm by ex vivo experiments.Results: The rapid pacing in HR up to 135 bpm reduced the total arterial compliance, stroke volume, systemic pulse pressure, and central systolic pressure by 36 ± 17, 38 ± 26, 29 ± 16, and 23 ± 12%, respectively, despite no statistical difference of mean aortic pressure, cardiac output, peripheral resistance, and vascular flow patterns. The pacing also resulted in a decrease of distensibility of small muscular arteries, but an increase of aortic distensibility. Pacing from 135 to 155 bpm had negligible effects on systemic and local hemodynamics and arterial stiffness.Conclusions: There is an acute mismatch in the response of aorta and small arteries to pacing from basal HR to 135 bpm, which may have important pathological implications under chronic tachycardia conditions.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Tachycardia Increases Aortic Distensibility, but Reduces Total Arterial Compliance Up to a Moderate Heart Rate

2018

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“…On the other hand, bisoprolol may be useful in hypertensive patients with cardiac or vascular diseases who have advanced atherosclerotic changes and sympathetic nervous system activation. Recently, the decrease in PR with ivabradine was associated with an increase in central SBP in patients with coronary artery disease 14) . However, in our study, such an effect was not observed in the hypertensive subjects, and the treatments did not cause a cardiovascular overload.…”

Section: )mentioning

confidence: 99%

Recent clinical trial of central hemodynamics

Eguchi

2017

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Abstract:Non-invasive measures of central hemodynamics, such as augmentation index (AI), and central blood pressure (BP) have emerged as a novel and more sophisticated method than brachial BP measurements. For the evaluation of cardiovascular risks and efficacy of medications, central hemodynamics have been shown to be better parameters than peripheral BP. We have introduced these measures of central hemodynamics in our clinical trials and found that 1) patients with type 2 diabetes (DM) had lower rAI but a higher central PP compared to that in the non-diabetes patients, which suggested a proximal conduit-predominant arterial stiffening causing reduced reflection coefficients at the systemic reflection sites: 2) An increased wave reflection caused by the stiffened aorta could be a key factor in the pathophysiology of hypertensive disorders of pregnancy: 3) Central BP compared to brachial clinic BP and home BP during antihypertensive treatment is better in predicting the measures of target organ damage: 4) a very aggressive antihypertensive therapy guided by home morning BP was effective for the change in the central SBP, and was correlated with the change in urinary albumin and PWV: 5) When beta-blockers were additionally used for the treatment of hypertension, bisoprolol achieved a greater reduction in pulse rate and improved baroreflex sensitivity and vascular stiffness, whereas celiprolol reduced the central BP. In conclusion, central hemodynamics might be useful for the evaluation of intra-individual changes, such as drug efficacy or that of some interventions, reflecting the pathophysiological mechanisms of cardiovascular diseases.

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“…The duration of the cardiac cycle determines the length of diastole and influences the shape of the arterial pressure waveform (Wilkinson et al, 2000 ; Lantelme et al, 2002 ; Albaladejo et al, 2004 ; Haesler et al, 2004 ; Westerhof et al, 2008 ; Mackenzie et al, 2009 ; Benetos et al, 2010 ; Westerhof and Westerhof, 2013 ; Rimoldi et al, 2016 ). Recently, studies in both animals and humans using pacing or a selective negative chronotropic agent alleged evidence for an inverse relationship between PP and heart rate (HR) (Lantelme et al, 2002 ; Albaladejo et al, 2004 ; Haesler et al, 2004 ; Rimoldi et al, 2016 ). A lower HR prolongates diastole more than systole, widening PP (Figure 1 ; Folkow and Ely, 1998 ).…”

Section: Introductionmentioning

confidence: 99%

Modeling Arterial Pulse Pressure From Heart Rate During Sympathetic Activation by Progressive Central Hypovolemia

et al. 2018

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Heart rate (HR) has an impact on the central blood pressure (BP) wave shape and is related to pulse wave velocity and therefore to timing and duration of systole and diastole. This study tested the hypothesis that in healthy subjects both in rest and during sympathetic stimulation the relation between HR and pulse pressure (PP) is described by a linear effect model. Forty-four healthy volunteers were subjected to sympathetic stimulation by continuous lower body negative pressure (LBNP) until the onset of pre-syncopal symptoms. Changes in PP and HR were tracked non-invasively and modeled by linear mixed effect (LME) models. The dataset was split into two groups: the first was used for creating a model and the second for its evaluation. Models were created on the data obtained during LBNP. Model performance was expressed as absolute median error (1st; 3rd quantiles) and bias with limits of agreement (LOA) between modeled and measured PP. From rest to sympathetic stimulation, mean BP was maintained while HR increased (~30%) and PP decreased gradually (~20%). During baseline, PP could be modeled with an absolute error of 6 (4; 10) mm Hg and geometric mean ratio of the bias was 0.97 (LOA: 0.8–1.1). During LBNP, absolute median model error was 5 (4; 8) mmHg with geometric mean ratio 1.02 (LOA: 0.8–1.3). In conclusion, both during rest and during sustained sympathetic outflow induced by progressive central hypovolemia, a LME model of HR provides for an estimate of PP in healthy young adults.

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Selective Heart Rate Reduction With Ivabradine Increases Central Blood Pressure in Stable Coronary Artery Disease

Cited by 36 publications

References 31 publications

Acute Tachycardia Increases Aortic Distensibility, but Reduces Total Arterial Compliance Up to a Moderate Heart Rate

Acute Tachycardia Increases Aortic Distensibility, but Reduces Total Arterial Compliance Up to a Moderate Heart Rate

Recent clinical trial of central hemodynamics

Modeling Arterial Pulse Pressure From Heart Rate During Sympathetic Activation by Progressive Central Hypovolemia

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