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Abstract

Nebivolol, the most selective clinically available antagonist of beta1-adrenergic receptors, has an additional vasodilator action in human forearm resistance vasculature in normal and hypertensive patients, and in patients with coronary artery disease. This has been attributed to activation of the L-arginine/nitric oxide pathway. The present investigation compared hemodynamic effects of nebivolol with those of another selective beta1-adrenergic receptor antagonist, bisoprolol. The study was approved by the local research ethics committee. 15 patients (11 men, 4 women age 29-69 years) with uncomplicated mild essential hypertension diagnosed by World Health Organisation criteria, consented to take part. The design was a double blind randomised crossover. Following a two week washout, subjects were randomised to receive nebivolol (5 mg po daily) or bisoprolol (10 mg po daily) for 2 weeks, followed by a 2 week washout and 2 weeks on the other treatment. Measurements were made at the end of each baseline and each active treatment period. Heart rate fell during active treatment (from 65±2 to 53±3 min1 during bisoprolol, P<0.01 and from 64±3 to 59±3 min1 during nebivolol). Blood pressure (by sphygmomanometry) fell (bisoprolol: 143±3/90±2 to 127±3/80±2; nebivolol: 144±4/92±2 to 131±3/83±3; each P<0.01) during active treatments to a similar extent. In contrast, systemic vascular resistance index (measured by bioimpedance) fell during nebivolol (from 2855±201 to 2646±186 dyn min-5m2, P<0.01) but did not change significantly during bisoprolol treatment (baseline 2848±177, on treatment 2788±159 dyn min-5m2,). We conclude that nebivolol has a systemic vasodilator action in essential hypertension distinct from its beta1-adrenoceptor antagonist action.

Consultant - MENAUNI INTERNATIONAL

vasodilator property, beta-receptors, nebivolol
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© American Journal of Hypertension, Ltd. 2001
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