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Nebivolol exerts beneficial effect on small artery elasticity

05 Feb 2018

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 [0], borderline [1] or abnormal [2]) 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]

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Most Read Articles
Jairia Dela Cruz, 14 Jan 2019
The potassium-competitive acid blocker vonoprazan demonstrates superior efficacy in the treatment of patients with erosive oesophagitis compared with the proton pump inhibitor lansoprazole, with the results of a small trial showing that the former more rapidly provides complete sustained heartburn relief during the first week of therapy.
01 Mar 2016
Bathing with 2% chlorhexidine gluconate-medicated washcloth is cost-effective for the prevention of central line-associated bloodstream infection (CLABSI), based on a systematic review and meta-analysis of four studies.
08 Jan 2019
Treatment with spironolactone has shown consistent, albeit modest, clinical effectiveness in older patients with heart failure with reduced ejection fraction (HFrEF) regardless of renal eligibility criteria used, a recent study has shown.
Rachel Soon, 12 Dec 2018

MIMS Pharmacist presents an overview of superoxide dismutase (SOD) and its role in resisting the effects of oxidative stress and aging.