CAFE, an ASCOT substudy

1
CAFE, an ASCOT substudy

• Conduit Artery Function EvaluationAnglo-Scandinav
  ian Cardiac Outcomes Trial

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CAFE, an ASCOT substudy Objectives

• Examine the impact of 2 different BP-lowering
  regimens on brachial and central aortic blood
  pressures and other hemodynamic parameters
• Determine whether there is a relationship between
  measurements of central aortic BP and
  cardiovascular-related outcomes within the CAFE
  study cohort

CAFE Investigators. Circulation. 20061131213-25.
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CAFE Design
N 2199 5 UK ASCOT centers
n 126Excluded HR irregularity Poor waveforms
N 2073Evaluable for tonometry
n 1042Amlodipine perindopril
n 1031Atenolol bendroflumethiazide
n 1042 Intent-to-treatn 1038 Complete
information
n 1031 Intent-to-treatn 1030 Complete
information
Newer antihypertensive regimen Older
antihypertensive regimen
CAFE Investigators. Circulation. 20061131213-25.
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CAFE Methods
SP
? P
P1

• Radial artery waveforms measured via noninvasive
  applanation tonometry
• Augmentation index (AIx) defined as ratio of
  augmentation (? P) to central pulse pressure
  Alx (? P/PP) 100

Pressure(mm Hg)
DP
Incisura
ED
Time (msec)
SP central aortic systolic pressure DP
central aortic diastolic pressure ED ejection
duration
CAFE Investigators. Circulation. 20061131213-25.
5
CAFE Lower central aortic BP with newer vs older
antihypertensive regimen despite similar brachial
BP
140
Brachial SBP
135
130
Central aortic SBP
mm Hg
125
120
115
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
Time (years)
Amlodipine perindoprilAtenolol
bendroflumethiazide
CAFE Investigators. Circulation. 20061131213-25.
6
CAFE Lower augmentation index with newer
antihypertensive regimen
P lt 0.0001
Atenolol bendroflumethiazide
Amlodipine perindopril
Older antihypertensive regimen Newer
antihypertensive regimen
CAFE Investigators. Circulation. 20061131213-25.
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CAFE Summary

• Amlodipine perindopril showed substantial and
  consistent differences in central aortic BP and
  hemodynamics compared to atenolol
  bendroflumethiazide, despite similar brachial
  systolic BP changes
• Differential effects on central aortic systolic
  BP and central aortic pulse pressure may explain
  the differences in clinical outcomes observed in
  ASCOT-BPLA
• Central aortic pulse pressure may be a
  determinant of CV outcomes

CAFE Investigators. Circulation. 20061131213-25.