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Nebivolol more potent than irbesartan for intradialytic hypertension

12 Aug 2019

Treatment with nebivolol yields more favourable changes in 24-hour, intradialytic and daytime systolic and diastolic blood pressure (BP) variability (BPV) in patients with intradialytic hypertension, a study has found.

The randomized crossover study included 38 patients (mean age, 60.4 years; 65.8 percent male) with intradialytic SBP increase of ≥10 mm Hg in 4/6 consecutive sessions. They were randomly assigned to receive nebivolol 5 mg and then irbesartan 150 mg, or vice versa, with a 2-week washout period before initiation of the second drug.

All patients underwent 24-hour ambulatory BP monitoring (ABPM) sessions. Researchers calculated the standard deviation (SD), weighted SD (wSD), coefficient of variation and average real variability of BP with validated formulas.

Treatment with either drug led to a significantly lower posthaemodialysis and 24-hour SBP and DBP levels. The systolic-BPV indices were slightly reduced after nebivolol but not after irbesartan: SD differences from baseline, –1.25 (p=0.090) and –0.31 (p=0.706), respectively; wSD differences from baseline, –1.22 (p=0.053) and –0.26 (p=0.805), respectively.

On the other hand, the diastolic-BPV indices decreased with nebivolol and increased with irbesartan, resulting in significant differences between the two drugs: SD differences from baseline, –0.81 and 0.28, respectively (between-drug, p=0.014); wSD differences from baseline, –0.52 and 0.39, respectively (between-drug, p=0.029).

The diastolic-BPV during intradialytic and daytime periods was slightly reduced with nebivolol vs irbesartan. Neither drug produced changes in all BPV indices during night-time.

The findings support the hypothesis that sympathetic-overdrive may be a major factor that affects BPV in intradialytic hypertension patients, the researchers said. More studies are needed to establish whether BPV reductions may translate into long-term benefits in cardiac function and the reduction of cardiovascular events in haemodialysis patients.

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Most Read Articles
Pearl Toh, 20 Nov 2019
The trade-off between the risk of ischaemic vs bleeding events may be different between Asian and non-Asian patients, which warrants careful consideration when deciding on the duration of antiplatelet therapy following a percutaneous coronary intervention (PCI), according to a presentation at ESC Asia Congress 2019.
2 days ago
Participating in a long-distance skiing event may help lower the risk of hypertension, with the number of completed races showing a weak association with the risk, a study has found.
06 Sep 2019
Hypertensive adults with lower plasma zinc concentration are at increased risk of haemorrhagic stroke, especially those with higher body mass index or lower plasma copper levels, a study has found.
06 Jan 2020
Target organ damage appears to be more noticeable in patients affected by primary aldosteronism than those affected by arterial hypertension without primary aldosteronism, suggests a study, adding that specific treatment can ease such condition.