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Carmela Morizzo, Francesca Vittone, Armando Magagna, Michaela Kozakova, Marco Ciardetti, Maria A. Morales, Antonio L'Abbate, Carlo Palombo, P-240: Endothelium-dependent vasodilation at peripheral microvascular level in hypertensive patients before and after therapy with nebivolol, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 109A, https://doi.org/10.1016/S0895-7061(01)01430-3
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Abstract
Background: Nebivolol is a new beta-adrenergic blocking agent which has been shown to cause vasodilation when infused in the forearm vascular bed both in normotensive and in hypertensive subjects, and this effect is probably mediated by the activation of the L-arginine/NO pathway.
Aim of the study: to investigate cutaneous microvascular function in hypertensive (HT) patients before and after treatment with Nebivolol.
Methods: in 11 never treated essential mild to moderate HT patients (mean age 48±9 years, 8 males, mean SBP/DBP 150±8/100±4 mmHg) and in 20 normotensive controls (NT, mean age 50±7 years, mean SBP/DBP 118±12/72±9 mmHg), skin blood flow (SBF) was studied by means of laser doppler flowmetry (LDF) at baseline and after administration by iontophoresis of stepwise doses of Acetylcholine (ACh) and Sodium Nitroprusside (SNP), in order to explore the endothelium-dependent and independent vasodilation. In the HT group, the same protocol was repeated after 15 to 21 days of treatment with Nebivolol (5mg/die).
Results: SBF significantly increased with ACh and SNP in NT and HT(p<.05 vs basal). During Nebivolol, blood pressure significantly decreased in all patients (mean SBP/DBP 129±12/81±9 mmHg, p<.05 vs baseline). SBF response to both vasoactive agents did not significantly differ after therapy in the overall population. However, when the dose-response curves to ACh in HT patients were compared to those obtained in NL, we could point out two subgroups: A) with a similar to normal, or enhanced response to ACh (SBFmax-SBFbasal>SBFmean-1sd than NT), B) with a depressed response to ACh (SBFmax-SBFbasal≤SBFmean-1sd than NT). After therapy, group B showed significantly increased vasodilatory response to ACh, while group A showed a decreased one, as compared to pre-treatment response (ANOVA, p.<.05 vs pre-treatment). No differences were present when comparing SNP dose-response curves before and after Nebivolol.
Conclusion: in patients with arterial hypertension, Nebivolol selectively improves endothelium-dependent microcirculatory vasodilation in patients with basally blunted response. By contrast, patients with basally normal response to ACh show a reduction in microcirculatory response, probably related to prevalence of peripheral beta-blocking effect when pre-treatment endothelium dependent vasodilation is preserved.
