CAFE, an ASCOT substudy Conduit Artery Function Evaluation Anglo-Scandinavian Cardiac Outcomes Trial.

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Presentation transcript:

CAFE, an ASCOT substudy Conduit Artery Function Evaluation Anglo-Scandinavian Cardiac Outcomes Trial

VBWG CAFE, an ASCOT substudy: Objectives Examine the impact of 2 different BP-lowering regimens on brachial and central aortic blood pressures and other hemodynamic parameters Determine whether there is a relationship between measurements of central aortic BP and cardiovascular- related outcomes within the CAFE study cohort CAFE Investigators. Circulation. 2006;113:

VBWG CAFE: Design N = UK ASCOT centers N = 2073 Evaluable for tonometry n = 126 Excluded: HR irregularity Poor waveforms n = 1042 Amlodipine ± perindopril* n = 1031 Atenolol ± bendroflumethiazide n = 1042 Intent-to-treat n = 1038 Complete information n = 1031 Intent-to-treat n = 1030 Complete information CAFE Investigators. Circulation. 2006;113: *Newer antihypertensive regimen Older antihypertensive regimen

VBWG CAFE: Methods Radial artery waveforms measured via noninvasive applanation tonometry Augmentation index (AIx) defined as ratio of augmentation ( P) to central pulse pressure: Alx = ( P/PP) × 100 CAFE Investigators. Circulation. 2006;113: SP = central aortic systolic pressure DP = central aortic diastolic pressure ED = ejection duration Pressure (mm Hg) P SP P1P1 DP Incisura Time (msec) ED

VBWG CAFE: Lower central aortic BP with newer vs older antihypertensive regimen despite similar brachial BP Amlodipine ± perindopril Atenolol ± bendroflumethiazide Time (years) mm Hg Brachial SBP Central aortic SBP CAFE Investigators. Circulation. 2006;113:

VBWG CAFE: Lower augmentation index with newer antihypertensive regimen P < Amlodipine ± perindopril Atenolol ± bendroflumethiazide* CAFE Investigators. Circulation. 2006;113: *Older antihypertensive regimen Newer antihypertensive regimen

VBWG CAFE: Summary Amlodipine ± perindopril showed substantial and consistent differences in central aortic BP and hemodynamics compared to atenolol ± bendroflumethiazide, despite similar brachial systolic BP changes Differential effects on central aortic systolic BP and central aortic pulse pressure may explain the differences in clinical outcomes observed in ASCOT-BPLA Central aortic pulse pressure may be a determinant of CV outcomes CAFE Investigators. Circulation. 2006;113: