Nebivolol reduces central blood pressure in stage I hypertensive patients
experimental single cohort study
Keywords:
Adrenergic beta-antagonists, Vasodilator agents, Arterial pressure, Pulse wave analysis, HypertensionAbstract
CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital. METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2 ) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.
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Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113(9):1213-25.
Roman MJ, Devereux RB, Kizer JR, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007;50(1):197-203.
Roman MJ, Devereux RB, Kizer JR, et al. High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study. J Am Coll Cardiol. 2009;54(18):1730-4.
Protogerou AD, Papaioannou TG, Blacher J, et al. Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target? J Hypertens. 2007;25(2):265-72.
Wang JG, Staessen JA, Franklin SS, Fagard R, Gueyffier F. Systolic and diastolic blood pressure lowering as determinants of cardiovascular outcome. Hypertension. 2005;45(5):907-13.
Polónia J, Barbosa L, Silva JA, Bertoquini S. Different patterns of peripheral versus central blood pressure in hypertensive patients treated with β-blockers either with or without vasodilator properties or with angiotensin receptor blockers. Blood Press Monit. 2010;15(5):235-9.
Mahmud A, Feely J. Beta-blockers reduce aortic stiffness in hypertension but nebivolol, not atenolol, reduces wave reflection. Am J Hypertens. 2008;21(6):663-7.
Kampus P, Serg M, Kals J, et al. Differential effects of nebivolol and metoprolol on central aortic pressure and left ventricular wall thickness. Hypertension. 2011;57(6):1122-8.
Agabiti-Rosei E, Porteri E, Rizzoni D. Arterial stiffness, hypertension, and rational use of nebivolol. Vasc Health Risk Manag. 2009;5(1):353-60.
Boutouyrie P, Achouba A, Trunet P, Laurent S; EXPLOR Trialist Group. Amlodipine-valsartan combination decreases central systolic blood pressure more effectively than the amlodipine-atenolol combination: the EXPLOR study. Hypertension. 2010;55(6):1314-22.
Wilkinson IB, Franklin SS, Cockcroft JR. Nitric oxide and the regulation of large artery stiffness: from physiology to pharmacology. Hypertension. 2004;44(2):112-6.
Zanchetti A. Clinical pharmacodynamics of nebivolol: new evidence of nitric oxide-mediated vasodilating activity and peculiar haemodynamic properties in hypertensive patients. Blood Press Suppl. 2004;1:17-32.
Ignarro LJ, Byrns RE, Trinh K, Sisodia M, Buga GM. Nebivolol: a selective beta(1)-adrenergic receptor antagonist that relaxes vascular smooth muscle by nitric oxide-and cyclic GMP-dependent mechanisms. Nitric Oxide. 2002;7(2):75-82.
Veverka A, Nuzum DS, Jolly JL. Nebivolol: a third-generation beta- adrenergic blocker. Ann Pharmacother. 2006;40(7-8):1353-60.
de Groot AA, Mathy MJ, van Zwieten PA, Perters SL. Involvement of the beta3 adrenoceptor in nebivolol-induced vasorelaxation in the rat aorta. J Cardiovasc Pharmacol. 2003;42(2):232-6.
Gielen W, Cleophas TJ, Agrawal R. Nebivolol: a review of its clinical and pharmacological characteristics. Int J Clin Pharmacol Ther. 2006;44(8):344-57.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-87.
Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-605.
Vaz-de-Melo RO, Pimenta AG, Giollo Júnior LT, et al. Fatores associados ao aumento no índice de incremento de pressão radial em indivíduos hipertensos [Factors associated with increased radial augmentation index in hypertensive individuals]. Arq Bras Cardiol. 2011;97(3):241-8.
Safar ME, Jankowski P. Central blood pressure and hypertension: role in cardiovascular risk assessment. Clin Sci (Lond). 2009;116(4):273-82.
Agabiti-Rosei E, Mancia G, O’Rourke MF, et al. Central blood pressure measurements and antihypertensive therapy: a consensus document. Hypertension. 2007;50(1):154-160.
Morgan T, Lauri J, Bertram D, Anderson A. Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens. 2004;17(2):118-23.
Schneider MP, Delles C, Klingbeil AU, et al. Effect of angiotensin receptor blockade on central haemodynamics in essential hypertension: results of a randomised trial. J Renin Angiotensin Aldosterone Syst. 2008;9(1):49-56.
Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta- analysis. Lancet. 2005;366(9496):1545-53.
Bangalore S, Messerli FH, Kostis JB, Pepine CJ. Cardiovascular protection using beta-blockers: a critical review of the evidence. J Am Coll Cardiol. 2007;50(7):563-72.
Ram CV. Beta-blockers in hypertension. Am J Cardiol. 2010; 106(12):1819-25.
Vitale C, Marazzi G, Iellamo F, et al. 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. Int J Cardiol. 2012;155(2):279-84.
Kamran H, Salciccioli L, Bastien C, et al. Effect of beta blockers on central aortic pressure in African-Americans. J Am Soc Hypertens. 2011;5(2):94-101.
Cockcroft J. A review of the safety and efficacy of nebivolol in the mildly hypertensive patient. Vasc Health Risk Manag. 2007; 3(6):909-17.
