The Effect of Low‐Dose Carvedilol, Nebivolol, and Metoprolol on Central Arterial Pressure and Its Determinants: A Randomized Clinical Trial

In this prospective, open‐label, randomized, controlled clinical trial the effects of low‐dose carvedilol, nebivolol, and metoprolol on central arterial pressure and augmentation index (AIx) and its heart rate–corrected value (AIx@75) were assessed. The authors randomized 75 hypertensive patients (1...

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Published in:The journal of clinical hypertension (Greenwich, Conn.) Conn.), 2013-12, Vol.15 (12), p.910-917
Main Authors: Studinger, Péter, Tabák, Ádám G., Chen, Chen‐Huan, Salvi, Paolo, Othmane, Taha E.H., Torzsa, Péter, Kapocsi, Judit, Fekete, Bertalan C., Tislér, András
Format: Article
Language:English
Subjects:
Adolescent
Adrenergic beta-1 Receptor Antagonists - administration & dosage
Adrenergic beta-1 Receptor Antagonists - therapeutic use
Adult
Aged
Arterial Pressure - drug effects
Benzopyrans - administration & dosage
Benzopyrans - therapeutic use
Carbazoles - administration & dosage
Carbazoles - therapeutic use
Carvedilol
Ethanolamines - administration & dosage
Ethanolamines - therapeutic use
Female
Heart Rate - drug effects
Humans
Hypertension - drug therapy
Hypertension - physiopathology
Male
Manometry
Metoprolol - administration & dosage
Metoprolol - therapeutic use
Middle Aged
Nebivolol
Original Paper
Original Papers
Propanolamines - administration & dosage
Propanolamines - therapeutic use
Prospective Studies
Treatment Outcome
Young Adult
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Summary:In this prospective, open‐label, randomized, controlled clinical trial the effects of low‐dose carvedilol, nebivolol, and metoprolol on central arterial pressure and augmentation index (AIx) and its heart rate–corrected value (AIx@75) were assessed. The authors randomized 75 hypertensive patients (18–70 years) to carvedilol 12.5/25 mg, metoprolol 50/100 mg, or nebivolol 2.5/5 mg daily and followed them up for 3 months. Central arterial pressure and AIx were measured with applanation tonometry at baseline and at the end of follow‐up. Analyses were restricted to 60 completers. Central systolic pressure decreased equally in all 3 treatment arms. AIx remained unchanged, while AIx@75 decreased significantly by 5.4%±2.5% in the nebivolol group. According to general linear models, individual change in heart rate was a strong predictor of change in AIx in the carvedilol group (r2=0.23, P=.03) although no similar association was found in the nebivolol group (r2=0.09). The impact of β‐blockers with vasodilator effects on pressure augmentation seems to be different with nebivolol having the largest potential of decreasing AIx@75. While AIx changes associated with carvedilol treatment are strongly driven by heart rate changes, those associated with nebivolol treatment seem to be the result of other mechanisms.
ISSN:1524-6175
1751-7176
DOI:10.1111/jch.12210