1. Impact of Heart Rate on Central Aortic Pressures and Hemodynamics Analysis From the CAFE (Conduit Artery Function Evaluation) Study : CAFE-Heart Rate Bryan Williams, MD, Peter S. Lacy, PHD, for the CAFE and the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Investigators Leicester, United Kingdom J Am Coll Cardiol 2009;54:705–13 R3 Park hyunjin

2. Background Beta-blockers –Primary treatment for hypertension –Less effective at preventing cardiovascular events compared with alternative agents CAFE(Conduit Artery Function Evaluation) study –Atenolol vs Amlodipine Atenolol : less effective at lowering central aortic systolic and pulse pressures(PPs), despite similar brachial BP –Central aortic pressures : independent predictor of clinical outcomes in hypertensive patients –Shortfall in benefit from beta-blockers could relate to less effective central aortic pressure lowering, despite similar brachial BP?

3. Objectives

4. Methods CAFÉ study population and design –Substudy of the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) study –2,073 pts from 5 ASCOT study centers in the UK and Ireland –Median follow-up : 3 years –Hypertensive patients(>90% treated) –Amlodipine ± perindopril vs Atenolol ± bendroflumethiazide-K Brachial BP : Validated semi- automated oscillometric device Radial pulse wave analysis : Radial artery applanation tonometry Augmentation index (AIx) = (ΔP/PP) × 100

5. Results – Relationship between HR and Brachial or Central pressure SBP Pulse pressure

6. Results – Multiple regression anaslysis of hemodynamic variables

7. Results – Atenolol vs amlodipine after adjustment for HR

8. Conclusions The CAFE-Heart Rate study –Lower HR is associated with higher central aortic systolic and PPs in patients with treated hypertension –Beta-blocker based therapy Lower HR Higher central aortic systolic and PPs Less effective at reducing cardiovascular events, especially stroke, when compared with other treatments in patients with hypertension