Effects of atenolol, perindopril and verapamil on haemodynamic and vascular function in Marfan syndrome-a randomised, double-blind, crossover trial
European Journal of Clinical Investigation, 08/02/2012
Williams A et al. – Perindopril, verapamil and atenolol all reduced peripheral and central systolic pressure. As atenolol slowed heart rate and delayed aortic wave travel, β–blockade may have a continuing role in the treatment of patients with Marfan syndrome.Methods
- Eighteen patients had applanation tonometry, pulse wave analysis and echocardiography, before and after atenolol 75mg, perindopril 4mg and verapamil 240mg, each given for 4 weeks, in a random order, with 2weeks between medications.
- Fourteen patients completed the study.
- Within–drug comparisons demonstrated that perindopril (–10•3mmHg, P=0•002), verapamil (–9•2mmHg, P=0•003) and atenolol (–7•1mmHg, P=0•01) all reduced central systolic pressure and brachial pressure; central changes were least, and peripheral changes greatest with atenolol but between–drug comparisons (analysis of covariance) were not significant.
- There was a trend for augmentation to be reduced by perindopril (–6•3%, P=0•05), verapamil (–5•5%, P=0•07) and atenolol (–3•2%, P=0•09).
- Only atenolol reduced heart rate (by 16%) and delayed expansion in the arch and abdominal aorta (by 8% and 11%) (P<0•001, P<0•01 and P<0•05, respectively, for between–drug comparisons).