Nebivolol more potent than irbesartan for intradialytic hypertension
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.