{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T05:11:12Z","timestamp":1790485872608,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Antihypertensive treatment may have different effects on central arterial hemodynamics. The extent of the difference in effects between various antihypertensive drugs remains undefined.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We conducted a systematic review and meta-analysis of randomized controlled trials that explored the effects of antihypertensive agents on both central and peripheral systolic blood pressure (SBP) and pulse pressure (PP) or central augmentation index, with a special focus on the comparison between newer [renin-angiotensin-aldosterone system (RAS) inhibitors and calcium-channel blockers (CCBs)] and older antihypertensive agents (diuretics and \u03b2- and \u03b1-blockers).<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In total, 20 studies (<jats:italic>n<\/jats:italic> = 2,498) were included. Compared with diuretics (10 studies), \u03b2-blockers (16 studies), or an \u03b1-blocker (1 study), RAS inhibitors (21 studies), and CCBs (6 studies) more efficaciously (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) reduced both central and peripheral SBP by a weighted mean difference of \u22125.63 (\u22126.50 to \u22124.76 mmHg) and \u22121.97 mmHg (\u22122.99 to \u22120.95 mmHg), respectively. Compared with older agents, the newer agents also more efficaciously (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) reduced central PP (\u22123.27 mmHg; \u22124.95 to \u22121.59 mmHg), augmentation index (\u22126.11%; \u22127.94 to \u22124.29) and augmentation (\u22123.35 mmHg; \u22125.28 to \u20131.42 mmHg) but not peripheral PP (<jats:italic>p<\/jats:italic> \u2265 0.09). Accordingly, the newer agents reduced central-to-peripheral PP amplification significantly less than the older agents (0.11 mmHg; 0.05 to 0.17 mmHg; <jats:italic>P<\/jats:italic> &amp;lt; 0.001).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Newer agents, such as RAS inhibitors and CCBs, were significantly more efficacious than older agents in their effects on central hemodynamics.<\/jats:p>","DOI":"10.3389\/fphys.2021.762586","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:17:00Z","timestamp":1638310620000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Antihypertensive Treatment and Central Arterial Hemodynamics: A Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3389","volume":"12","author":[{"given":"Yi-Bang","family":"Cheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Hui","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Guang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1161\/01.STR.0000236839.69658.c5","article-title":"Candesartan- and atenolol-based treatments induce different patterns of carotid artery and left ventricular remodeling in hypertension.","volume":"37","author":"Ariff","year":"2006","journal-title":"Stroke"},{"key":"B2","first-page":"S15","article-title":"Amelioration of arterial properties with a perindopril-indapamide very-low-dose combination.","volume":"19","author":"Asmar","year":"2001","journal-title":"J. Hypertens. Suppl."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1161\/HYPERTENSIONAHA.109.148999","article-title":"Amlodipine-valsartan combination decreases central systolic blood pressure more effectively than the amlodipine-atenolol combination: the explor study.","volume":"55","author":"Boutouyrie","year":"2010","journal-title":"Hypertension"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1016\/S0140-6736(04)17355-8","article-title":"Atenolol in hypertension: is it a wise choice?","volume":"364","author":"Carlberg","year":"2004","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1161\/01.hyp.25.5.1034","article-title":"Different effects of fosinopril and atenolol on wave reflections in hypertensive patients.","volume":"25","author":"Chen","year":"1995","journal-title":"Hypertension"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-19998-4","article-title":"Central and cerebral haemodynamic changes after antihypertensive therapy in ischaemic stroke patients: a double-blind randomised trial.","volume":"8","author":"Choi","year":"2018","journal-title":"Sci. Rep."},{"key":"B7","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/S0140-6736(05)67185-1","article-title":"Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the anglo-scandinavian cardiac outcomes trial-blood pressure lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial.","volume":"366","author":"Dahl\u00f6f","year":"2005","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1161\/HYPERTENSIONAHA.106.085803","article-title":"Similar effects of treatment on central and brachial blood pressures in older hypertensive subjects in the second australian national blood pressure trial.","volume":"49","author":"Dart","year":"2007","journal-title":"Hypertension"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1161\/HYPERTENSIONAHA.115.06091","article-title":"Impact of ivabradine on central aortic blood pressure and myocardial perfusion in patients with stable coronary artery disease.","volume":"66","author":"Dillinger","year":"2015","journal-title":"Hypertension"},{"key":"B10","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1093\/ajh\/hps003","article-title":"Impact of heart rate on central hemodynamics and stroke: a meta-analysis of beta-blocker trials.","volume":"26","author":"Ding","year":"2013","journal-title":"Am. J. Hypertens."},{"key":"B11","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1097\/MAJ.0b013e3181d658c4","article-title":"Combination therapy of calcium channel blocker and angiotensin II receptor blocker reduces augmentation index in hypertensive patients.","volume":"339","author":"Doi","year":"2010","journal-title":"Am. J. Med. Sci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.vph.2015.06.004","article-title":"Combination therapy with lercanidipine and enalapril reduced central blood pressure augmentation in hypertensive patients with metabolic syndrome.","volume":"92","author":"Ghiadoni","year":"2017","journal-title":"Vascul. Pharmacol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/0197-2456(95)00134-4","article-title":"Assessing the quality of reports of randomized clinical trials: is blinding necessary?","volume":"17","author":"Jadad","year":"1996","journal-title":"Control Clin. Trials"},{"key":"B14","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1007\/s00380-016-0924-9","article-title":"The effects of alpha 1-adrenoceptor blockade and angiotensin converting enzyme inhibition on central and brachial blood pressure and vascular reactivity: the doxazosin-ramipril study.","volume":"32","author":"Jekell","year":"2017","journal-title":"Heart Vessels"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1097\/HJH.0b013e3280ac1533","article-title":"Superior effect of an angiotensin-converting enzyme inhibitor over a diuretic for reducing aortic systolic pressure.","volume":"25","author":"Jiang","year":"2007","journal-title":"J. Hypertens."},{"key":"B16","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1038\/hr.2013.112","article-title":"Efficacy of losartan and carvedilol on central hemodynamics in hypertensives: a prospective, randomized, open, blinded end point, multicenter study.","volume":"37","author":"Kim","year":"2014","journal-title":"Hypertens. Res."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2423","DOI":"10.1097\/00004872-200212000-00022","article-title":"AT1-receptor blockade improves augmentation index: a double-blind, randomized, controlled study.","volume":"20","author":"Klingbeil","year":"2002","journal-title":"J. Hypertens."},{"key":"B18","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1161\/HYPERTENSIONAHA.115.06066","article-title":"Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis.","volume":"67","author":"Kollias","year":"2016","journal-title":"Hypertension"},{"key":"B19","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jash.2013.09.001","article-title":"Effects of renin-angiotensin-aldosterone system inhibitors and beta-blockers on markers of arterial stiffness.","volume":"8","author":"Koumaras","year":"2014","journal-title":"J. Am. Soc. Hypertens."},{"key":"B20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1272\/jnms.80.25","article-title":"The influence of a direct renin inhibitor on the central blood pressure.","volume":"80","author":"Kubota","year":"2013","journal-title":"J. Nippon Med. Sch."},{"key":"B21","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1038\/s41371-019-0187-x","article-title":"Association between central haemodynamics and risk of all-cause mortality and cardiovascular disease: a systematic review and meta-analysis.","volume":"33","author":"Li","year":"2019","journal-title":"J. Hum. Hypertens."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2786","DOI":"10.1161\/01.cir.90.6.2786","article-title":"Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.","volume":"90","author":"London","year":"1994","journal-title":"Circulation"},{"key":"B23","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1161\/HYPERTENSIONAHA.109.133801","article-title":"Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension.","volume":"54","author":"Mackenzie","year":"2009","journal-title":"Hypertension"},{"key":"B24","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/j.1365-2125.2012.04342.x","article-title":"Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index.","volume":"75","author":"Manisty","year":"2013","journal-title":"Br. J. Clin. Pharmacol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1161\/HYPERTENSIONAHA.109.131466","article-title":"Differential effects between a calcium channel blocker and a diuretic when used in combination with angiotensin II receptor blocker on central aortic pressure in hypertensive patients.","volume":"54","author":"Matsui","year":"2009","journal-title":"Hypertension"},{"key":"B26","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s11906-009-0043-4","article-title":"Antihypertensive drugs and central blood pressure.","volume":"11","author":"McEniery","year":"2009","journal-title":"Curr. Hypertens. Rep."},{"key":"B27","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1093\/ajh\/hpv134","article-title":"Impact of antihypertensive agents on central systolic blood pressure and augmentation index: a meta-analysis.","volume":"29","author":"McGaughey","year":"2016","journal-title":"Am. J. Hypertens."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2017-000591","article-title":"Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study.","volume":"4","author":"Miyoshi","year":"2017","journal-title":"Open Heart"},{"key":"B29","doi-asserted-by":"publisher","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"535","DOI":"10.2147\/VHRM.S44568","article-title":"Comparative effectiveness of a fixed-dose combination of losartan + HCTZ versus bisoprolol + HCTZ in patients with moderate-to-severe hypertension: results of the 6-month ELIZA trial.","volume":"9","author":"Radchenko","year":"2013","journal-title":"Vasc. Health Risk Manag."},{"key":"B31","doi-asserted-by":"publisher","first-page":"181","DOI":"10.3109\/08037051.2013.840421","article-title":"Effects of nebivolol and atenolol on central aortic pressure in hypertensive patients: a multicenter, randomized, double-blind study.","volume":"23","author":"Red\u00f3n","year":"2014","journal-title":"Blood Press"},{"key":"B32","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/S0140-6736(10)60308-X","article-title":"Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension.","volume":"375","author":"Rothwell","year":"2010","journal-title":"Lancet"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3308","DOI":"10.1093\/eurheartj\/ehx525","article-title":"The effect of sacubitril\/valsartan compared to olmesartan on cardiovascular remodelling in subjects with essential hypertension: the results of a randomized, double-blind, active-controlled study.","volume":"38","author":"Schmieder","year":"2017","journal-title":"Eur. Heart J."},{"key":"B34","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3317\/jraas.2008.003","article-title":"Effect of angiotensin receptor blockade on central haemodynamics in essential hypertension: results of a randomised trial.","volume":"9","author":"Schneider","year":"2008","journal-title":"J. Renin Angiotensin Aldosterone Syst."},{"key":"B35","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1590\/1516-3180.2020.0364.R1.0412020","article-title":"Prediction of all-cause and cardiovascular mortality using central hemodynamic indices among elderly people: systematic review and meta-analysis.","volume":"139","author":"Vieceli","year":"2021","journal-title":"Sao Paulo Med. J."},{"key":"B36","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.ijcard.2011.10.099","article-title":"Effects of nebivolol or irbesartan in combination with hydrochlorothiazide on vascular functions in newly-diagnosed hypertensive patients: the NINFE (Nebivololo, Irbesartan Nella Funzione Endoteliale) study.","volume":"155","author":"Vitale","year":"2012","journal-title":"Int. J. Cardiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1016\/j.jacc.2009.10.061","article-title":"Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.","volume":"55","author":"Vlachopoulos","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1161\/HYPERTENSIONAHA.117.09972","article-title":"Labetalol versus nifedipine as antihypertensive treatment for chronic hypertension in pregnancy: a randomized controlled trial.","volume":"70","author":"Webster","year":"2017","journal-title":"Hypertension"},{"key":"B39","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1161\/HYPERTENSIONAHA.116.08556","article-title":"Effects of sacubitril\/valsartan versus olmesartan on central hemodynamics in the elderly with systolic hypertension: the parameter study.","volume":"69","author":"Williams","year":"2017","journal-title":"Hypertension"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1161\/CIRCULATIONAHA.105.595496","article-title":"Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study.","volume":"113","author":"Williams","year":"2006","journal-title":"Circulation"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2021.762586\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:17:03Z","timestamp":1638310623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2021.762586\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":40,"alternative-id":["10.3389\/fphys.2021.762586"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2021.762586","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]},"article-number":"762586"}}