Abstract
Objective: To compare the haemodynamic effects of nebivolol, a highly selective antagonist of β1-adrenergic receptors with additional actions caused via the L-arginine/nitric oxide pathway, with those of bisoprolol, another selective β1-adrenergic receptor antagonist.
Patients and methods: The study had a double-blind, randomised, crossover design, and was performed in an outpatient setting. Study participants comprised 15 patients (11 men, four women, aged 29 to 69 years) with uncomplicated mild essential hypertension. Patients were randomised to receive nebivolol (5mg orally daily) or bisoprolol (10mg orally daily) for 2 weeks, followed by a 2-week washout and 2 weeks of the other treatment. Measurements (by mercury sphygmomanometer and bioimpedance) were made at the end of each baseline and each active treatment period.
Results: Mean heart rate fell during active treatment (from 65 ± 2 to 53 ± 3 beats/min during bisoprolol, p < 0.05, and from 64 ± 3 to 59 ± 3 beats/min during nebivolol). Systolic/diastolic blood pressure fell during active treatments to a similar extent with each treatment (bisoprolol: 143 ± 3/90 ± 2mm Hg to 127 ± 3/80 ± 2mm Hg; nebivolol: 144 ± 4/92 ± 2mm Hg to 131 ± 4/83 ± 3mm Hg; each p < 0.01). In contrast, the systemic vascular resistance index fell during nebivolol (from 2854 ± 201 to 2646 ± 186 dyn·sec·cm−5·m2, p < 0.05), but did not change significantly during bisoprolol treatment (baseline 2848 ± 177, with treatment 2787 ± 159 dyn·sec·cm−5·m2).
Conclusion: The fall in systemic vascular resistance index during nebivolol (but not bisoprolol) treatment can be explained on the basis of a systemic vasodilator action of nebivolol. The clinical importance of this action requires further investigation.
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References
Gao YS, Nagao T, Bond RA, et al. Nebivolol induces endothelium-dependent relaxation of canine coronary arteries. J Cardiovasc Pharmacol 1991; 17: 964–9
Cockcroft JR, Chowienczyk PJ, Brett SE, et al. Nebivolol vasodilates human forearm vasculature: evidence for an L-arginine/NO dependent mechanism. J Pharmacol Exp Ther 1995; 274: 1067–71
Dawes M, Brett SE, Chowienczyk PJ, et al. The vasodilator action of nebivolol in forearm vasculature of subjects with essential hypertension. Br J Clin Pharmacol 1999; 48: 460–3
Robinson BF, Wilson AG. Effect on forearm arteries and veins of attenuation of the cardiac response to leg exercise. Clin Sci 1968; 35: 143–52
Broeders MAW, Doevendans PA, Bekkers B, et al. Nebivolol: a third generation β-blocker that augments vascular nitric oxide release. Endothelial β2-adrenergic receptor-mediated nitric oxide production. Circulation 2000; 102: 677–84
Petrie JC, O’Brien ET, Littler WA, et al. Recommendations on blood pressure measurement. BMJ 1986; 293: 611–5
Ng NWK, Walley T, Breckenridge AM. Comparison and reproducibility of transthoracic bioimpedance and dual beam Doppler ultrasound. Br J Clin Pharmacol 1991; 32: 275–82
Janssens WJ, Xhonneux R, Janssen PAJ. Animal pharmacology of nebivolol. Drug Invest 1991; 3(1 Suppl): 13–24
Goldstein M, Vincent J-L, De Smet J-M, et al. Administration of nebivolol after coronary artery bypass in patients with altered left ventricular function. J Cardiovasc Pharmacol 1993; 22: 253–8
De Cree J, Geukens H, Franken P, et al. Non invasive cardiac hemodynamics of nebivolol in men. Acta Antwerpiensia 1989; 6: 2–21
Jennings G, Esler M, Dart A, et al. Effects of nebivolol on haemodynamics, cardiac dimension and function, cardiovascular reflexes and bichemical measure of sympathetic activity in normal human subjects. Drug Invest 1991; 3: 51–9
Bowman AJ, Chen CP, Ford GA. Nitric oxide mediated venodilator effects of nebivolol. Br J Clin Pharmacol 1994; 38: 199–204
Kubli S, Feihl F, Waeber B. Beta-blockade with nebivolol enhances the acetylcholine-induced cutaneous vasodilation. Clin Pharmacol Ther 2001; 69: 238–44
Tzemos N, Lim PO, McDonald T. Nebivolol reverses endothelial dysfunction in essential hypertension. Circulation 2001; 104: 511–4
De Cree J, Franken PH, Vandevivere J, et al. Haemodynamic effects of nebivolol in men: comparison of radionuclide angiocardiography with systolic time intervals. Angiology 1988; 39: 526–34
Duprez D, Lefebvre R, De Backer T, et al. Influence of nebivolol on cardiovascular haemodynamics during postural changes and isometric exercise. Drug Invest 1991; 3 Suppl. 1: 144–5
Uhlir O, Dvorak I, Gregor P, et al. Nebivolol in the treatment of cardiac failure: a double blind controlled clinical trial. J Card Fail 1997; 3(4): 271–6
Rousseau MF, Chapelle F, Van Eyll C, et al. Medium-term effects of beta-blockade on left ventricular mechanics: a double blind, placebo-controlled comparison of nebivolol and atenolol in patients with ischemic left ventricular dysfunction. J Card Fail 1996; 2: 15–23
Wisenbaugh T, Katz I, Davis J, et al. Long term (3-month) effect of a new beta-blocker (nebivolol) on cardiac performance in dilated cardiomyopathy. J Am Cardiol 1993, 1100
Burkat F, Pfisterer M, Sheinmann E. Effects of bisoprolol in relation to metoprolol and bufuralol on left ventricular hemodynamics at rest and during exercise in chronic ischemic heart disease. J Cardivasc Pharmacol 1986; 8: 578–84
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This study was supported by Menarini International.
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Brett, S.E., Forte, P., Chowienczyk, P.J. et al. Comparison of the Effects of Nebivolol and Bisoprolol on Systemic Vascular Resistance in Patients with Essential Hypertension. Clin. Drug Investig. 22, 355–359 (2002). https://doi.org/10.2165/00044011-200222060-00002
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DOI: https://doi.org/10.2165/00044011-200222060-00002