Pulse Wave Velocity Medication is crucial because increased arterial stiffness and consequently elevated pulse wave velocity (PWV) in the aorta and major arteries can lead to damage the heart and other vital organs. Therefore, managing PWV through appropriate medication helps reduce the risk of cardiovascular diseases and related complications by improving arterial flexibility and overall blood flow.
On one hand, high blood pressure (hypertension) is a major cause of cardiovascular diseases. On the other hand, while blood pressure medications can lower PWV, we don’t know if this happens because they help relax stiff arteries directly or if they cause other changes that indirectly affect arterial stiffness [1].
This article will cover different antihypertensive medications that reduce Pulse Wave Velocity, their uses, benefits, and possible side effects.
ACE Inhibitors and PWV
Angiotensin-converting enzyme (ACE) inhibitors are a top choice for people dealing with heart failure and chronic kidney disease. They don’t just help lower blood pressure; they also provide heart protection for those at high risk of heart problems. Most ACE inhibitors are taken as pills, but there’s one called enalapril that can also be given through an IV if needed. When it’s given this way, the starting dose is usually between 0.625 to 1.25 mg every 6 hours, and it can go up to 5 mg every 6 hours if necessary. For older adults, it’s best to start with a lower dose to be safe.
Like any medication, ACE inhibitors can have side effects. The most common ones include a dry cough (which can happen in about 10% to 20% of users), dizziness (12% to 19%), low blood pressure (7% to 11%), and increased levels of certain substances in the blood, like blood urea nitrogen (BUN) and creatinine (2% to 11%). Some people might also experience fainting (about 5% to 7%) or high potassium levels (hyperkalemia) in 2% to 6% of cases [2].
Ramipril is one of the most well-known ACE inhibitors for reducing pulse wave velocity (PWV). It has been shown to lower aortic PWV by 1.7±0.2 m/s, highlighting its effectiveness in improving arterial stiffness [3].
ARBs and PWV
Angiotensin II receptor blockers (ARBs) are considered an important type of medicine for treating high blood pressure. Substantial reductions in both diastolic and systolic blood pressure can be achieved with ARB monotherapy or by combining ARBs with other types of blood pressure medications [4].
Basically, blood pressure is lowered by angiotensin II receptor blockers (ARBs) because they block the AT1 receptors. As a result, their effects are similar to those of angiotensin-converting enzyme (ACE) inhibitors, which work by stopping the production of angiotensin II [5].
Currently, losartan, valsartan, and candesartan are three common angiotensin II receptor blockers (ARBs) available on the market. The highest recommended doses are 100 mg per day for losartan, 320 mg per day for valsartan, and 32 mg per day for candesartan [6].
ARBs are usually well tolerated and have few side effects, with lower chances of angioedema (swelling) and cough compared to ACE inhibitors, as ARBs don’t raise bradykinin levels. However, there are rare cases of these issues in some patients using ARBs. They can also cause low blood pressure and/or kidney problems in patients whose blood pressure or kidney function depends heavily on the renin-angiotensin-aldosterone system (RAAS). For this reason, ARBs should not be used in patients with narrowed renal arteries on both sides or in those with heart failure and low blood pressure [7].
CCBs and PWV
Calcium channel blockers (CCBs), also called calcium channel antagonists, are commonly used to treat different conditions like high blood pressure, coronary heart disease, and chronic stable angina.
CCBs work by stopping calcium from entering certain cells in the body, particularly in the heart, blood vessels, and pancreas. There are two main types of CCBs:
- Non-dihydropyridines: These CCBs slow down the heart’s electrical signals and reduce the force of heart contractions. This helps lower blood pressure, decreases the heart’s need for oxygen, and controls fast heart rhythms.
- Dihydropyridines: These CCBs mainly relax and widen blood vessels rather than affecting the heart directly. This makes them effective for treating high blood pressure, easing blood flow after a brain bleed, and preventing migraines.
Overall, CCBs help improve blood flow and reduce the workload on the heart.
Dihydropyridine and Non-Dihydropyridine Calcium Channel Blockers: Key Differences
A selection of various agents from each class (Non-dihydropyridines or Dihydropyridines) is provided below.
Dihydropyridine agents include several options. Amlodipine is available as oral tablets, while felodipine is offered as an extended-release (ER) oral tablet that releases the medication slowly. Nicardipine can be found in oral capsules as well as injectable formulations. Nisoldipine is also available as an ER oral tablet, allowing for a gradual release of the drug into the body.
Non-dihydropyridine agents include diltiazem and verapamil. Diltiazem is provided in multiple forms, including 12- and 24-hour ER capsules, immediate-release tablets, ER tablets, and injectable formulations. Verapamil is available in various oral formulations, such as 24-hour ER capsules for both morning and evening dosing, immediate-release tablets, ER tablets, and injectable forms. These options allow healthcare providers to choose the most suitable form for each patient’s needs [8].
Non-dihydropyridine medications may lead to side effects such as constipation, dizziness, fatigue, and low blood pressure when standing up. Dihydropyridine medications can also cause side effects, including lightheadedness, flushing, headaches, and swelling in the legs (peripheral edema) due to fluid movement in the body. Both types of medications have varying side effects depending on the specific drug used.
Calcium channel blockers lower pulse wave velocity (PWV) and reduce wave reflections, although not as effectively as renin-angiotensin inhibitors. The strongest evidence supports the use of amlodipine, a dihydropyridine calcium channel blocker. Amlodipine was shown to lower central blood pressure more than peripheral blood pressure. It also increased pulse pressure and reduced arterial stiffness, as indicated by lower augmentation index (Aix) and PWV, demonstrating its ability to make arteries less stiff [9].
P.S: Lercanidipine is a third-generation dihydropyridine medication that is taken once a day for hypertension management appears to be one of the best options among other CCBs [10].
Beta-blockers and PWV
Beta-blockers are a group of medicines mainly used to treat cardiovascular diseases and other conditions. Basically, there are three types of beta receptors in the body: beta-1 (B1), beta-2 (B2), and beta-3 (B3).
- Beta-1 receptors are mostly found in the heart and help control how the heart works.
- Beta-2 receptors are found in different parts of the body and help relax muscles and control metabolism.
- Beta-3 receptors help break down fat but are less important in medicine right now. Beta-blockers work by blocking these receptors to treat different illnesses.
They are commonly used as first-line treatment for both serious and long-term diseases [11].
Sometimes athletes and performers (like musicians) use beta-blockers because these medicines help reduce anxiety and calm the body. Beta-blockers are often used to reduce symptoms like a fast heartbeat, sweating, and muscle tension. They can also lower the risk of cardiovascular problems and death in younger patients. However, in people over 65, their protective effects are weaker and may increase the risk of stroke [12].
Third-Generation Beta-Blockers: Carvedilol and Nebivolol Overview
Third-generation beta-blockers, such as carvedilol and nebivolol, are advanced medications that help widen blood vessels, making them effective for certain cardiovascular diseases.
- Carvedilol:
Mechanism: It is a non-selective beta-blocker that also blocks alpha receptors and has antioxidant properties.
Function: Carvedilol helps relax blood vessels mainly by blocking alpha receptors.
Absorption: This medication is quickly absorbed and processed by the liver, making it suitable for patients with heart failure and other cardiovascular issues.
Clinical Evidence: Carvedilol can lower death rates in patients with heart failure and those recovering from heart attacks.
- Nebivolol:
Mechanism: This drug is highly selective for beta-1 receptors and stimulates the production of nitric oxide, which helps relax blood vessels.
Function: Nebivolol works by increasing nitric oxide levels, leading to widened blood vessels.
Dosage: The maximum dose is 40 mg taken once a day [13].
Clinical Evidence: Nebivolol has also shown positive effects in treating heart failure and high blood pressure, especially in older patients [14].
Beta-blockers can mainly cause two side effects: slow heart rate and leg pain from poor blood flow. A slow heart rate, called bradycardia, can occur if the medicine slows the heartbeat too much, leading to fatigue, dizziness, or fainting. Leg pain, known as intermittent claudication, happens when blood flow to the legs is reduced, causing discomfort during activities like walking or exercising. While these side effects can be worrisome, they are quite rare compared to the number of people taking beta-blockers [15].
Beta-blockers have a moderate effect on pulse wave velocity medication. However, certain beta-blockers that also have vasodilator properties, like nebivolol, can reduce pulse wave analysis parameters, meaning central blood pressure and augmentation index (AIx). This is likely due to an increase in nitric oxide levels, which helps widen blood vessels. These vasodilating effects improve the function of the inner lining of blood vessels (endothelial function) and can lead to a long-term decrease in arterial stiffness [16].
Follow-Up on Pulse Wave Velocity Medication
The Arteriograph is a non-invasive device that measures arterial stiffness quickly and accurately, without the need for surgical procedures or needles. While there is no specific drug designed to lower pulse wave velocity, antihypertensive medications are primarily used in what is referred to as “Pulse Wave Velocity Medication” to enhance vascular health. By utilizing the Arteriograph, healthcare providers can effectively monitor the impact of these medications, offering valuable insights into a patient’s treatment progress and overall arterial health.
Contact us to get answers to any questions you may have or to get a quote for the Arteriograph set.