Nebivolol exerts beneficial effect on small artery elasticity
Treatment with nebivolol in asymptomatic individuals with prehypertension or borderline blood pressure (BP) provides superior improvements in small artery function compared with atenolol in spite of their similar BP-lowering effect, a study has found.
A total of 60 individuals with prehypertension or borderline BP and abnormal small artery elasticity (SAE) had been randomized to receive placebo (n=22), nebivolol 5/10 mg/day (n=20) or atenolol 25/50 mg/day (n=18) once daily for 9 months.
All participants underwent assessment with multiple tests, including large and small artery elasticity, resting and treadmill exercise BP, carotid intimal-media thickness, retinal vascular photography, microalbuminuria, electrocardiography, echocardiography, and plasma B-type natriuretic peptide level. Scores for each test (normal , borderline  or abnormal ) were added to determine the total disease score (DS).
At 9 months, mean DS decreased significantly from baseline with nebivolol (from 4.3 to 2.8; p<0.007) and atenolol (from 5.4 to 3.5; p=0.0006) but only numerically with placebo (from 5.2 to 4.5; p=0.18).
Of note, nebivolol produced an increase in SAE (from 6.0 to 8.4 ml/mmHg × 100; p=0.0001). On the other hand, no significant change in SAE was observed with atenolol or placebo.
Researchers underscored the importance of the beneficial effect of nebivolol on SAE in the early treatment of asymptomatic cardiovascular disease (CVD). Given that SAE is a marker for endothelial dysfunction, the favourable effects of nebivolol on endothelial function suggest that the drug may slow progression of early CVD more effectively atenolol.
A number of individuals with normal BP values may be at high risk of developing CVD events, and this population are generally not treated with antihypertensive drugs, although many develop morbid events without manifesting hypertensive BP readings. In these patients, therapy must be targeted at vascular and cardiac protection rather than BP reduction. [Lancet 2016;387:957-967]