Comparison of nebivolol and atenolol on blood pressure, blood sugar, and lipid profile in patients of essential hypertension

Badar, Vandana; Hiware, Sachin K.; Shrivastava, Meena; Thawani, Vijay; Hardas, Mrunalini M.

doi:10.4103/0253-7613.83117

Cited by 19 publications

(22 citation statements)

References 11 publications

(12 reference statements)

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“…These results correlate to the study done by Van Bortel 13 with the exception that no significant changes in HDL cholesterol and TGs were observed in the respective study. However, our findings are in contrast with Pesant et al 20 and Badar et al 21 who showed in their studies that there was no change in lipid parameters in patients on treatment with nebivolol. Similarly, a study by Peter et al in patients of type 2 diabetes with mild to moderate hypertension exhibited no significant changes in serum cholesterol or TGs following treatment with nebivolol, but a significant increase in HDL cholesterol was noted.…”

Section: Discussioncontrasting

confidence: 99%

To study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension

Johar

Bhosle

Jaybhaye

et al. 2015

Int J Basic Clin Pharmacol

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INTRODUCTIONEssential or primary hypertension is the most prevalent type, affecting between 90% and 95% of patients diagnosed with hypertension.1 It has been reported to be the fourth contributor to premature death in developed countries and the seventh in developing countries.2 Recent reports indicate that nearly 1 billion adults (more than a quarter of the world's population) had hypertension in 2000, and this is predicted to increase to 1.56 billion by 2025.3 However, prevalence of hypertension in India, for the last three decades has increased by about 30 times among urban residents and by about 10 times among rural residents. 4 Hypertension and certain alteration in serum lipoproteins are complementary coronary risk factors. Several studies have indicated that high concentrations of low-density lipoprotein (LDL) cholesterol and triglyceride (TG) are strong risk factors for the development of cardiovascular disease (CVD). 5,6 It has been reported that the effect of antihypertensive agents on lipid metabolism exhibits a wide range. Some have adverse effect on the lipid profile whereas others have a neutral or favorable effect on it.7 Beta-adrenergic receptor antagonists (beta-blockers) are widely used for the management of CVDs and have been proved efficacious in the treatment of hypertension, coronary heart disease, including angina pectoris, myocardial infarction, and heart failure. Sixty patients of either sex in the age group of 30-65 years with blood pressure (BP) of ≥140/90 mmHg with deranged lipid parameters according to National Cholesterol Education Program were randomized into two groups. Group I received metoprolol (50 mg) and Group II received nebivolol (5 mg), both given once daily for 12 weeks. BP and lipid parameters were evaluated at baseline as well as at the end of 12 weeks. Results: There was significant reduction in BP values (p<0.0001) as compared to baseline in both the groups, however no significant difference was observed between two drugs revealing that their efficacy in reducing systolic BP/diastolic BP is comparable. Furthermore, both the drugs had a favorable effect on lipid profile, but more significant results on lipid profile were observed in the nebivolol group as compared to metoprolol group (p<0.0001). Conclusions: In our comparison study, it is seen that the favorable effect of nebivolol on serum lipids and its good tolerability profile make it a good choice for control of hypertension as well as preventing the long-term cardiovascular morbidities and mortalities.

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Section: Discussioncontrasting

confidence: 99%

To study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension

Johar

Bhosle

Jaybhaye

et al. 2015

Int J Basic Clin Pharmacol

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“…3 Furthermore, in addition to the changes in lipid levels, more patients in the metoprolol group had initiation of statin therapy or their statin dose increased compared with those in the carvedilol group (32% vs. 11%, p=0.04). 27 Similar results have also been observed in 2 small trials comparing the metabolic effects of nebivolol with atenolol 8 and metoprolol. 11 In a secondary analysis of the large, multinational Carvedilol Or Metoprolol European Trial, patients without DM who were randomized to carvedilol were less likely to develop DM compared with those randomized to metoprolol (HR=0.78, p=0.048).…”

Section: Discussionsupporting

confidence: 72%

“…2–5, 7 In head-to-head trials, patients with DM who were treated with vasodilating (vs. traditional) beta-blockers had small but significant decreases in hemoglobin A1c levels, improved insulin sensitivity, lower cholesterol levels, less weight gain, and less progression to microalbuminuria. 3, 8–11 However, these findings have not been confirmed in the real-world clinical practice environment.…”

mentioning

confidence: 87%

Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Arnold

Spertus

Lipska

et al. 2014

American Heart Journal

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Background Discharge beta-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous beta-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive beta-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control post-discharge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005–08), we investigated the frequency of “DM-friendly” beta-blocker prescription at discharge by DM status. Beta-blockers were classified as DM-friendly (e.g., carvedilol, labetalol), or non-DM-friendly (e.g., metoprolol, atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly beta-blocker use. Among DM patients, we examined the association of DM-friendly beta-blockers with worsened glycemic control at 6 months after MI. Results Of 4031 MI patients, 1382 (34%) had DM. Beta-blockers were prescribed at discharge in 93% of patients. DM-friendly beta-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly beta-blocker compared with patients without DM (13.5% vs. 10.3%, p=0.003), an association that remained after multivariable adjustment (OR 1.41, 95% CI 1.13–1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly vs. non-friendly beta-blockers (RR 0.80, 95% CI 0.60–1.08). Conclusion The vast majority of DM patients were prescribed non-DM friendly beta-blockers—a practice that was associated with a trend towards worse glycemic control post-discharge. While in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of beta-blockers use in patients with DM.

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“…In this study for 6 months, SBP reduced from 160.13±1.62 mm Hg to 118.93±0.87 mm Hg in atenolol arm and from 159.93±1.62 mm Hg to 116.73±0.91 mm Hg in nebivolol. Similar responses were observed with DBP and HR 33. Thus, whether Indian patients are highly responsive to β blockers or there is contribution by placebo effect needs be investigated further.…”

Section: Discussionmentioning

confidence: 55%

Efficacy and tolerability of a β-1 selective β blocker, bisoprolol, as a first-line antihypertensive in Indian patients diagnosed with essential hypertension (BRIGHT): an open-label, multicentric observational study

Channaraya¹,

Marya²,

Somasundaram

et al. 2012

BMJ Open

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ObjectivesThis study was aimed to evaluate the efficacy and tolerability of bisoprolol, in Indian patients diagnosed with stage I essential hypertension as first-line drug.DesignThis was an open-label, phase IV, multicentric prospective study.Settings239 outpatient centres across India.ParticipantsAfter ethical approval, patients who were willing to sign informed consent, who are newly diagnosed with JNC VII stage I essential hypertension (systolic blood pressure 140–159 mm Hg or diastolic blood pressure 90–99 mm Hg) and who are prescribed bisoprolol were enrolled in the study. Patients with significant organ disease or complications, women of childbearing age refusing reliable contraceptive method, patients with known contraindications (like symptomatic bradycardia, significant atrioventricular blockade, sick sinus syndrome) and patients with known hypersensitivity reactions to bisoprolol and unwilling patients were excluded.Primary and secondary outcomes measuresThe primary outcome measure was percentage of patients achieving blood pressure (BP) ≤140/90 mm Hg at the end of 12 weeks, while multiple secondary outcome measures were assessed.ResultsOf 2418 patients screened, 2161 patients were recruited (66.64% men, mean age 51.7±9.8 years, smokers 19.19%) and 2131 (96.44%) patients achieved BP control. There was significant reduction in systolic blood pressure (−25.29; SD: 13.22 mm Hg), diastolic blood pressure (−14.14; SD: 7.67 mm Hg) and heart rate (−12/min; SD: 6.15) compared with baseline (all p values <0.05). The median dose of bisoprolol and average period required for the response were 5 mg/day and 33 days, respectively. Bisoprolol was found to be well tolerated in the patients up to 10 mg/day. A total of 1.9% patients showed adverse events, which were mild to moderate in severity without any severe adverse event. None required treatment withdrawal.ConclusionBisoprolol is an effective and safe option to control BP. Thus, it can be used as one of the first-line antihypertensive in Indian patients.

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Comparison of nebivolol and atenolol on blood pressure, blood sugar, and lipid profile in patients of essential hypertension

Cited by 19 publications

References 11 publications

To study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension

To study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension

Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Efficacy and tolerability of a β-1 selective β blocker, bisoprolol, as a first-line antihypertensive in Indian patients diagnosed with essential hypertension (BRIGHT): an open-label, multicentric observational study

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