A comparison of atenolol and nebivolol in isolated systolic hypertension
A comparison of atenolol and nebivolol in isolated systolic hypertension
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DOI：
10.1097/hjh.0b013e3282f283c9
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发表时间：
2008-02-01
影响因子：
4.9
通讯作者：
Wilkinson, Ian B.
中科院分区：
文献类型：
--
作者：
Dhakam, Zahid;Yasmin;Wilkinson, Ian B.
目的 一些β受体阻滞剂在降低中心血压方面不如其他抗高血压药物有效，这可能解释了最近试验中随机接受阿替洛尔的受试者中事件发生率较高的原因。我们假设奈必洛尔（一种混合 β 受体阻滞剂/硝基血管扩张剂）在降低中心血压和增强指数 (AIx) 方面比阿替洛尔更有效。本研究的目的是通过一项双盲、随机、交叉研究，在一组患有孤立性收缩期高血压的受试者中对此进行测试。方法在为期 2 周的安慰剂磨合后，16 名从未治疗过的高血压受试者以随机顺序接受阿替洛尔 (50 mg)、奈比洛尔 (5 mg) 和安慰剂，各治疗 5 周。测量坐位肱动脉血压和心率。以无创方式评估主动脉血压、AIx 和脉搏波速度 (PWV)。 结果 奈必洛尔和阿替洛尔之间安慰剂校正的肱动脉压下降相似，PWV 下降也相似（平均变化 +/- SEM：-1.0 +/- 0.3 和 -1.2 +/- 0.2 m/s；P=0.2）。然而，服用奈比洛尔后，心率降低幅度较小（-19 +/- 2 对比 -23 +/- 2 次/分钟；P< 0.01），AIx 增加（+6 +/- 1 对比 +10 +/- 1%；P=0.04）。使用奈必洛尔后主动脉脉压显着降低（50 +/- 2 与 54 +/- 2mmHg；P=0.02）。两种药物的 N 端 B 型利钠肽原 ( proBNP) 均升高（100 +/- 33 对比 75 +/- 80 pg/ml；两者 P<0.01，NS 进行比较）。结论 奈必洛尔和阿替洛尔对肱动脉血压和主动脉僵硬度具有相似的影响。然而，奈必洛尔比阿替洛尔更能降低主动脉脉压，这可能与 AIx 和心动过缓的升高不太明显有关。这是否会转化为临床结果的差异需要进一步研究。
Objectives Some beta-blockers are less effective in reducing central blood pressure than other antihypertensive drugs, which may explain the higher rate of events in subjects randomized to atenolol in recent trials. We hypothesized that nebivolol, a mixed beta-blocker/ nitro-vasodilator, would be more effective than atenolol in reducing central blood pressure and augmentation index ( AIx). The aim of the present study was to test this in a double-blind, randomized, cross-over study, in a cohort of subjects with isolated systolic hypertension.Methods Following a 2-week placebo run-in, 16 never-treated hypertensive subjects received atenolol ( 50 mg), nebivolol ( 5 mg) and placebo, each for 5 weeks, in a random order. Seated brachial blood pressure and heart rate were measured. Aortic blood pressure, AIx and pulse wave velocity ( PWV) were assessed non-invasively.Results The placebo-corrected fall in brachial pressure was similar between nebivolol and atenolol, as was the reduction in PWV ( mean change +/- SEM: -1.0 +/- 0.3 and -1.2 +/- 0.2 m/s; P=0.2). However, there was less reduction in heart rate (-19 +/- 2 versus -23 +/- 2 beats/ min; P< 0.01) and increase in AIx (+6 +/- 1 versus +10 +/- 1%; P=0.04), following nebivolol. Aortic pulse pressure was significantly lower ( 50 +/- 2 versus 54 +/- 2mmHg; P=0.02) after nebivolol. N-terminal pro-B-type natriuretic peptide ( proBNP) rose on both drugs (100 +/- 33 versus 75 +/- 80 pg/ ml; P< 0.01 for both, NS for comparison).Conclusions Nebivolol and atenolol have similar effects on brachial blood pressure and aortic stiffness. However, nebivolol reduces aortic pulse pressure more than atenolol, which may be related to a less pronounced rise in AIx and bradycardia. Whether this will translate into differences in clinical outcome requires further investigation.