Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study

Vaz-de-Melo, Renan Oliveira; Giollo-Júnior, Luiz Tadeu; Martinelli, Débora Dada; Moreno-Júnior, Heitor; Mota‐Gomes, Marco A.; Cipullo, José Paulo; Vilela-Martin, José Fernando

doi:10.1590/1516-3180.2014.1325704

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…Nebivolol, a third‐generation β 1 ‐selective β‐blocker, has shown favorable effects on carbohydrate and lipid metabolism, as well as on endothelial function and oxidative stress. Nebivolol was shown to improve arterial stiffness to a greater extent than older β‐blockers, increase the bioavailability of nitric oxide, decrease oxidative stress, and also have an antiproliferative effect . Thus, the current article is in accordance with previous findings in general.…”

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confidence: 91%

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Are All β‐Blockers the Same? Nebivolol Vasodilator Properties and Evidence for Relevance in Treatment of Hypertension

Kanbay

Afsar

2014

J of Clinical Hypertension

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In this issue of The Journal of Clinical Hypertension, Kandavar and colleagues 1 studied the circulatory changes in prehypertensive patients by digital plethysmography for measurement of blood flow and reactive hyperemic index (RHI). Additionally, they measured augmentation index (AI) and the effect of nebivolol therapy on L-arginine, asymmetric dimethlyarginine (ADMA), symmetric dimethlyarginine (SDMA), and L-citrulline levels after 8 weeks in a blinded fashion. Consequently, they demonstrated that 8 weeks of nebivolol therapy has no significant effect on RHI, ADMA, SDMA, or AI, whereas digital blood flow and L-citrulline levels were significantly increased after nebivolol therapy. They concluded that prehypertension is associated with increased ADMA and evidence of increased arterial stiffness and preserved RHI. Nebivolol therapy is associated with digital vasodilatation and increased nitric oxide production, as depicted by increased levels of L-citrulline and mean digital blood flow. Nebivolol, a third-generation b 1 -selective b-blocker, has shown favorable effects on carbohydrate and lipid metabolism, as well as on endothelial function and oxidative stress. Nebivolol was shown to improve arterial stiffness to a greater extent than older b-blockers, increase the bioavailability of nitric oxide, decrease oxidative stress, and also have an antiproliferative effect.2-4 Thus, the current article is in accordance with previous findings in general. It is well written and has good methodology. However, some issues have to be mentioned.First, the sample size is relatively small to reach firm conclusions. Apart from that in the nebivolol group, both systolic and diastolic blood pressure (BP) also decreased in the placebo group during follow-up, suggesting that some patients may have experienced the white-coat effect. Although the authors acknowledge this and admit that they did not perform ambulatory BP monitoring, this may be the major drawback given the fact that the baseline patient number was relatively low.Second, the authors state that ADMA levels are higher when compared with those in healthy individuals but there is no mention in the manuscript regarding the levels of ADMA in this population. In addition, there was no change in ADMA before and after treatment. These findings are not novel. Indeed, the same group previously demonstrated that nebivolol treatment was associated with stable ADMA levels, while treatment with metoprolol was associated with increased ADMA levels, which is an important finding to differentiate third-generation b-blockers from older ones. 5Recent evidence has shown that central BP is more relevant for predicting cardiovascular (CV) outcomes than peripheral pressure in the brachial artery. [6][7][8] Indeed, it was suggested that brachial BP does not reflect the pressure in the central circulation.9 In addition, different classes of antihypertensive drugs have different effects on the central BP and arterial stiffness.10 However, the current study did not show any beneficial effect of n...

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confidence: 91%

“…However, the current study did not show any beneficial effect of nebivolol treatment on AI despite reductions in BP . Vaz‐de‐Melo and colleagues demonstrated that nebivolol reduced central BP but not AI. In another study, the role of nebivolol treatment on central hemodynamics in 50 prehypertensive patients was investigated.…”

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confidence: 76%

Are All β‐Blockers the Same? Nebivolol Vasodilator Properties and Evidence for Relevance in Treatment of Hypertension

Kanbay

Afsar

2014

J of Clinical Hypertension

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“…After removing for duplicates, a final number of 35 articles were approached for full-text reading. Four studies were excluded for reporting only acute treatment-induced BP changes, [27][28][29][30] 5 because of incomplete central BP values at baseline or after treatment, 12,16,25,31,32 3 because of the inclusion criteria, 33-35 2 for duplicating other publications, 36,37 2 for the absence of a control group, 38,39 and 1 because central BP assessment was performed with a nonvalidated device. 40 Overall, 20 studies were included in the study for quantitative analysis, and the main characteristics are reported in Table 1 and Table S1 in the online-only Data Supplement.…”

Section: Study Selectionmentioning

confidence: 99%

Effects of β-Blockers With and Without Vasodilating Properties on Central Blood Pressure

et al. 2016

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Because the pressure waveform undergoes a progressive amplification ongoing from the heart to the peripheral sites, SBP and pulse pressure (PP) measured at the brachial level are generally higher than the corresponding aortic (central) values. At the individual level, pressure amplification is determined by the timing and amplitude of the reflected wave from peripheral sites, as well as by height, sex, heart rate, posture, arterial tapering, and the degree of peripheral vasoconstriction. 13 Thus, drugs with different effects on the physiological determinants of SBP amplification may result in different SBP-lowering effects at the aortic and brachial level. β-blocking agents, such as atenolol and metoprolol, negatively affect SBP amplification through a reduction in heart rate and a contemporary increase in peripheral vasoconstriction, which Abstract-β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure (cSBP) as compared with peripheral SBP (pSBP). Whether this effect is less pronounced with vasodilating β-blockers (VBB) when compared with nonvasodilating β-blockers (NVBB) remains unsettled. We conducted a systematic review and meta-analysis of randomized trials exploring the effects of β-blockers on both pSBP and cSBP in hypertension. We selected 20 studies, for a total of 32 treatment arms (n=21 for NVBB, n=11 for VBB) and 1263 participants (n=962 for NVBB, n=301 for VBB). pSBP decreased from 150 to 133 mm Hg for NVBB and from 145 to 134 mm Hg for VBB. cSBP decreased from 137 to 126 mm Hg for NVBB and from 132 to 123 mm Hg for VBB. SBP amplification (pSBPcSBP) decreased significantly under VBB (−5.6 mm Hg; 95% confidence interval, −7.8, −3.4 mm Hg), but not under NVBB (−1.1 mm Hg; 95% confidence interval, −3.4, +1.2 mm Hg; P<0.01 versus NVBB). There was high heterogeneity both within and between β-blockers subclasses. In a meta-regression model, the weighted difference in treatment-induced changes in SBP amplification between NVBB and VBB lost its significance after adjustment for mean age and baseline pSBP and heart rate (−2.9±2.3 mm Hg; P=0.22) and was almost abolished after adjustment for treatment-induced heart rate changes (−0.1±0.5 mm Hg; P=0.78). In conclusion, NVBBs, but not VBBs, determine a lower reduction in cSBP than in pSBP. However, the difference in treatment-induced SBP amplification changes between NVBB and VBB is nearly abolished after accounting for differences in heart rate changes. (Hypertension. 2016;67:316-324.

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“…It seems that the newer beta-blockers, including nebivolol, celliprolol and carvedilol, have greater vasodilating eff ects. Clinical evidence also suggests that these agents are more potent than conventional beta-blockers in reducing central systolic pressure [65,66,67], with recent studies suggesting that nebivolol is as effi cacious as ACEis, ARBs and aliskiren in this respect [56,57]. Likewise, among hypertensive patients, carvedilol and losartan reduce central pressure to a similar extent [68].…”

Section: Do Some Drug Classes Have More Benefi Cial Effects On Centramentioning

confidence: 99%

Clinical relevance of central blood pressure - a critical review

Kostapanos

McEniery

Wilkinson

2016

Vasa

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Summary: Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced effi cacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.

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Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study

Cited by 8 publications

References 29 publications

Are All β‐Blockers the Same? Nebivolol Vasodilator Properties and Evidence for Relevance in Treatment of Hypertension

Are All β‐Blockers the Same? Nebivolol Vasodilator Properties and Evidence for Relevance in Treatment of Hypertension

Effects of β-Blockers With and Without Vasodilating Properties on Central Blood Pressure

Clinical relevance of central blood pressure - a critical review

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