Nebivolol, But Not Metoprolol, Treatment Improves Endothelial Fibrinolytic Capacity in Adults With Elevated Blood Pressure

Stauffer, Brian L.; Dow, Caitlin A.; Diehl, Kyle J.; Bammert, Tyler D.; Greiner, Jared J.; DeSouza, Christopher A.

doi:10.1161/jaha.117.007437

Cited by 7 publications

(9 citation statements)

References 58 publications

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“…First of all, the comparable BP-lowering effect between nebivolol, previous BAAs and other antihypertensive agents was demonstrated in several studies including Stauffer et al, 80 Santos et al 81 85 that investigated the efficacy and tolerability of hypertensive treatment with byvalson and similarly found it to be very efficient. On this basis, nebivolol may be considered as first-line treatment in combination therapy.…”

Section: Discussionmentioning

confidence: 90%

“…First of all, the comparable BP‐lowering effect between nebivolol, previous BAAs and other antihypertensive agents was demonstrated in several studies including Stauffer et al, Santos et al and Duprez et al Nebivolol in antihypertensive combination therapy was likewise shown to have promising effects. The results of Grassi et al indicated that when using both office‐measured and holder BP monitoring, nebivolol is equal to AT 1 ‐R blockers regarding antihypertensive combination therapy with hydrochlorothiazide.…”

Section: Discussionmentioning

confidence: 91%

“…Stauffer et al investigated the antithrombotic actions of nebivolol and found that chronic treatment with nebivolol, as opposed to metoprolol, was capable of raising plasma tPA levels. This may be another aspect of nebivolol's improvements on endothelial dysfunction that consequently affects thrombogenesis.…”

Section: Discussionmentioning

confidence: 99%

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Nebivolol in the treatment of arterial hypertension

Olawi

Krüger

Grimm

et al. 2019

Basic Clin Pharma Tox

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This MiniReview reports the current knowledge about the treatment of arterial hypertension with the third‐generation beta‐adrenoceptor antagonist (BAA) nebivolol. Furthermore, it reviews the advantages of nebivolol compared to the earlier generation of BAAs with respect to their different pharmacological properties. Beta‐adrenoceptor antagonists are a class of drugs applied for several different conditions, including hypertension and heart failure. They differ significantly in their pharmacological properties, including varying β1/β2‐selectivity and/or exertion of additive effects on the heart and circulation. Although these drugs have been a part of hypertensive therapy for about 40 years, the outcome of large clinical trials has put the role of BAAs into question. However, most of these results were based on first‐ and second‐generation BAAs and cannot be translated directly into third‐generation drugs. The third‐generation BAA nebivolol has the highest β1‐selectivity seen so far, together with additional vasodilating and anti‐oxidative properties. It is currently applied in the treatment of hypertension and congestive heart failure. Nebivolol has a unique pharmacological profile, despite showing similar blood pressure‐lowering effects, and has certain advantages in the treatment of hypertension compared to the previous generations of BAAs. This includes significant improvements in endothelial dysfunction, central haemodynamics and the degree of erectile dysfunction in men, a neutral/beneficial metabolic profile and lastly a more favourable side effect profile. It is widely beneficial for, for example, sexually active men and patients with comorbidities such as type II diabetes mellitus, metabolic syndrome and chronic obstructive lung disorders. Whether the advantages translate to an improved long‐term clinical outcome remains to be clarified, and ongoing prospective studies will show this in the future.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 91%

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Nebivolol in the treatment of arterial hypertension

Olawi

Krüger

Grimm

et al. 2019

Basic Clin Pharma Tox

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“…Nebivolol contrasts with beta blockers, such as metoprolol and atenolol, which do not have vasodilatory effects, and nonselective beta blockers, such as carvedilol and labetalol, which have vasodilatory effects through alpha adrenergic blockade [11]. In human trials, nebivolol but not metoprolol has been found to reduce oxidative stress and endothelin-1-mediated vasoconstriction, and improve endothelial fibrinolytic capacity through increased bioavailability oftissue-type plasminogen activator (t-PA) [12,13]. Nebivolol has been associated with beneficial cardiovascular effects including improved cardiac output, reduced arterial stiffness, reduced oxidative stress, improvements in glucose/lipid metabolism, and reduced platelet volume and aggregation [11].…”

Section: Introductionmentioning

confidence: 99%

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

Huck

Rosenberg

Stauffer

2022

Journal of Hypertension

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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.

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“…Unlike atenolol, nebivolol did not worsen insulin sensitivity in hypertensive patients with impaired glucose tolerance [7]. In addition to these distinctive metabolic features, both carvedilol and nebivolol improved endothelial function in contrast to conventional β-blockers [8,9]. Moreover, vasodilating β-blockers do not elevate central blood pressure by reducing vascular resistance [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Long-term efficacy of vasodilating β-blocker in patients with acute myocardial infarction: nationwide multicenter prospective registry

Chung

Han

Yang

et al. 2021

Korean J Intern Med

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Background/Aims: Long-term benefit of vasodilating β-blockers is unknown. This study aimed to investigate the long-term benefit of vasodilating β-blockers over conventional β-blockers in patients with acute myocardial infarction (AMI). Methods: Using nationwide prospective multicenter Korean Acute Myocardial Infarction Registry data, we analyzed 3-year clinical outcomes of 7,269 patients with AMI who received percutaneous coronary intervention (PCI) and β-blocker therapy. Patients were classified according to treatment strategy (vasodilating β-blockers vs. conventional β-blockers). The primary endpoint was a composite of cardiac death, myocardial infarction (MI), and hospitalization for heart failure (HF) at 3 years. Secondary outcomes were each component of the primary outcome. Propensity score matching was performed to adjust for differences of baseline characteristics. Results: In 3,079 pairs (6,158 patients) of propensity score-matched patients, the primary outcome occurred significantly less in the vasodilating β-blockers group compared with the conventional β-blockers group (7.6% vs. 9.8%, p = 0.003). Among the secondary outcomes, cardiac death occurred significantly less in the vasodilating β-blockers group than in the conventional group (3.5% vs. 4.8%, p = 0.015). The incidence rates of MI (2.4% vs. 3.0%, p = 0.160) or hospitalization for HF (2.6% vs. 3.2%, p = 0.192) were not significantly different between the two groups. Conclusions: Vasodilating β-blocker therapy was associated with better clinical outcomes compared with conventional β-blocker therapy in AMI patients undergoing PCI during 3 years follow-up. Vasodilating β-blockers could be recommended preferentially for these patients.

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Nebivolol, But Not Metoprolol, Treatment Improves Endothelial Fibrinolytic Capacity in Adults With Elevated Blood Pressure

Cited by 7 publications

References 58 publications

Nebivolol in the treatment of arterial hypertension

Nebivolol in the treatment of arterial hypertension

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

Long-term efficacy of vasodilating β-blocker in patients with acute myocardial infarction: nationwide multicenter prospective registry

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