Impact of concomitant use of beta blocker, statin, aspirin, and metformin on central hemodynamics and arterial stiffness in hypertension

Objective: To assess the impact of concomitant use of aspirin, BB (metoprolol), statin (atorvastatin), and metformin on central haemodynamics and arterial stiffness parameters in treated hypertensive patients. Materials and Methods: We did a cross-sectional study on 476 treated hypertensives. Oscillometric PWA was accomplished by Mobil-o-Graph (IEM, Germany) and groups were stratified using low-dose aspirin, statin, BB, or metformin. Parameters studied were brachial hemodynamics (BP, heart rate, and rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification), and central hemodynamics (central BP, cardiac output, and stroke work). Results: All pairs were matched by or comparable for major confounding factors except concomitant use of drugs. The use of BB, aspirin, and statin had favorable effect on brachial and central hemodynamics. Metformin use had effect more on central than brachial hemodynamics. BB and metformin had negative, statin had indifferent, and aspirin had positive effect on arterial stiffness. Only few of these differences had statistical significance. Frequency of central pulse pressure ≥40 was insignificantly affected by drugs studied. Conclusions: Concomitant aspirin, BB, and metformin in hypertensives have favorable effects on hemodynamics, brachial more than central. Arterial stiffness has positive impact of metformin and negative impact of BB use. These effects must be considered in studies focusing hypertensive therapies. It remains inconclusive whether these results are due to drugs or their indication.