Comparative Efficacy of Nebivolol and Bisoprolol in Terms of Impact on Central Blood Pressure and Elastic Properties of the Arteries in Patients with Mild to Moderate Hypertension
Background. Nowadays search for novel facilities for cardiovascular risk reduction in general population is widely discussed. In many randomized trials the value of arterial wall stiffness in worsening prognosis for cardiac patients was demonstrated. Therefore, based on these considerations, therapy, consisting of beta-blockers with vasodilatation properties, perhaps, may have most significant effect in terms of prevention of major cardiovascular events.
However these properties of the main representatives of beta-blockers have not been studied enough. On the one hand, this is due to that fact that most of the controlled trials were carried out using low-selective beta-blocker atenolol. On the other hand, there are only few studies that compare the efficacy of different beta-blockers with one another.
Aim. The aim of this study was to compare the efficacy of bisoprolol and nebivolol in improving the elastic properties of arteries.
Materials and Methods. We observed 40 patients with mild to moderate hypertension (24 men, 16 women). All patients were divided into 2 groups of therapy with nebivolol (n = 20) and with bisoprolol (n = 20). If target blood pressure was not achieved hydrochlorothiazide was added. The routine examination at baseline and after 6 months of follow-up included office systolic (SBP) and diastolic (DBP) blood pressure measurement, ambulatory blood pressure monitoring, central blood pressure measurement, evaluation of pulse wave velocity (PWV), heart rate (HR) and the lipids levels.
Results. After analysis of all data it was established that office SBP and DBP decreased significantly in patients both with and moderate hypertension in nebivolol group. At the end of the follow-up period there was a significant reduction in office SBP and DBP in both groups (30.5/15.95 mmHg in nebivolol group and 30.35/17.65 mmHg in bisoprolol group). Office HR decreased in groups by 10.40 and 7.85 bpm respectively. This significant decrease in office BP can be explained by the fact that in case of failure of target BP levels achievement after 1 month of therapy, second drug hydrochlorothiazide was added.
Level of central SBP was significantly reduced in both groups, but in nebivolol group this reduction was significantly greater compared with bisoprolol one — 17.55 ± 3.86 and 8.67 ± 1.57 mmHg respectively. The difference in the achievement of the central SBP was 8.88 mmHg (p < 0.05). We have also noted improved elastic properties of the arteries due to reduction of PWV in the two groups both in conducting and muscular arteries. However, the difference had been observed in the dynamics of PWV while analyzing the groups separately. Thus, in nebivolol group a significant decrease in PWV in conducting arteries has been revealed — by 1.61 m/s. In bisoprolol group PWVe reduction by 1 m/s has been also observed, but it was not significant (probably due to the small number of observations).
Conclusion. In the same reduction of office and ambulatory BP, in nebivolol group central aortal pressure decreased more significantly than in bisoprolol group, perhaps, due to vasodilatation properties of nebivolol. Pulse wave velocity decreased significantly only in nebivolol group.
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