Nebivolol and incident cardiovascular events in hypertensive patients compared with nonvasodilatory beta blockers

Abstract

Objective: Nonvasodilatory beta blockers are associated with inferior cardiovascular event reduction compared with other antihypertensive classes, and there is uncertainty about first-line use of beta blockers for hypertension in guidelines. The third generation vasodilatory beta blocker nebivolol has unique beneficial effects on central and peripheral vasculature. Our objective was to compare longitudinal cardiovascular outcomes of hypertensive patients taking nebivolol with those taking the nonvasodilatory beta blockers metoprolol and atenolol.Methods: We performed a retrospective cohort analysis of hypertensive adults in the University of Colorado health system, without preceding diagnosis of cardiovascular or cerebrovascular disease. The primary outcome was composite incident heart failure, stroke, myocardial infarction, angina, or coronary revascularization. Mahalanobis 1:2 distance matching and Cox proportional hazards regression was used. Matching and regression variables included baseline demographics, socioeconomic factors, medical insurance type, prescribing provider type, cardiovascular risk factors, Charlson comorbidity index, other medications, and follow-up duration.Results: After matching, patients were predominantly women (54%, 3085 of 5705) and non-Hispanic Caucasian (79%, 4534 of 5705), with median age of 58. In matched Cox regression analysis, nebivolol was associated with 17% reduction in incident cardiovascular events compared with all nonvasodilatory beta blockers [hazard ratio 0.83, 95% confidence interval (CI) 0.74-0.94, P ¼ 0.004], and 24% reduction compared with metoprolol (hazard ratio 0.76, CI 0.66-0.87, P ¼ 0.0001). Conclusion:The vasodilatory beta blocker nebivolol was associated with reduced incident cardiovascular events compared with nonvasodilatory beta blockers. Additional study of other beta blockers is necessary to determine if this is a vasodilatory beta blocker class effect or is specific to nebivolol.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…In one study, there was no statistically significant difference in CV outcomes between 118 133 patients receiving either nebivolol or carvedilol and 267 891 patients receiving atenolol [588]. In other studies, use of nebivolol led to greater CV protection compared with use of atenolol or metoprolol [589,590].…”

European guidelines for the treatment of arterial hypertension 2023: new trends

“…Кроме того, были проведены еще два наблюдательных исследования по оценке преимуществ небиволола, обладаю щего вазодилатирующим действием, при лечении АГ. Первое исследование основано на ретроспективном анализе когорты 5705 пациентов с АГ без предварительного диагноза сердечно-сосудистых или цереброваскулярных заболеваний [19]. Согласно регрессионному анализу Кокса, небиволол был связан с 17% случаев снижения сердечно-сосудистых событий по сравнению Рисунок 2.…”