- Email: [email protected]
COMPARATIVE EFFECTS OF METOPROLOL AND NEBIVOLOL ON BLOOD PRESSURE CONTROL IN AFRICAN-AMERICANS
913 JACC March 21, 2017 Volume 69, Issue 11
Heart Failure and Cardiomyopathies COMPARATIVE EFFECTS OF METOPROLOL AND NEBIVOLOL ON BLOOD PRESSURE CONTROL IN AFRICAN-AMERICANS Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Heart Failure and Cardiomyopathies: Heart Failure Is Just a Revolving Door Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy Presentation Number: 1293-246 Authors: Adebayo Atanda, Julius Ngwa, Otelio Randall, Howard University Hospital, Washington, DC, USA
Background: Beta blockers (BB) are well established drugs in management of hypertension. We aim to compare effects of two BB Metoprolol and Nebivolol, a third generation BB with vasodilatory property mediated by nitric oxide release, on blood pressure (BP) control.
Methods: This is a prospective, double-blind, randomized, two arms trial. We randomly assigned 101 African Americans (AA), age 18 to 80 with treated or untreated Stage I hypertension, i.e.140-159/90-99 mmHg to one of two treatment groups A or B, for 16 weeks. Concomitant antihypertensive therapy was permitted. Treatment started with Dose 1 (5 mg Nebivolol or 50 mg metoprolol succinate), then titrated to Dose 2 (double Dose 1) or Dose 3 (double Dose 2) during the scheduled visit depending on office BP response to dose 1 or 2. Subjects proceeded sequentially with labs, office BP measurements and ECHO. Results: Following 16 weeks of therapy, there was a significant decrease in mean systolic blood pressure of 19.09 mmHg among participants taking treatment A (p < 0.001) and 18.97 mmHg for participants taking treatment B (p < 0.001). The mean diastolic blood pressure was also significantly reduced within the treatment groups with treatment A having reduction of 11.63 mmHg (p < 0.001) and treatment B having a similar reduction of 11.62 mmHg (p < 0.001) after the 16 weeks’ therapy. However, there is no statistically significant differences in the BP reduction between the treatment groups. There was only 1 incident of side effect in each group. Conclusions: Although Nebivolol has been shown to be very effective for reducing BP in hypertensive subjects, this study reveals that there is no difference between nebivolol and metoprolol on office blood pressure control in African-Americans after 16 weeks of therapy. This could be related to impaired endothelial function attributed to reduced endothelial nitric oxide bioavailability in African Americans. Additional studies in stage II hypertensive subjects that allow titration to higher doses are needed as the effects of nebivolol on various receptors are dose dependent.
Heart Failure and Cardiomyopathies COMPARATIVE EFFECTS OF METOPROLOL AND NEBIVOLOL ON BLOOD PRESSURE CONTROL IN AFRICAN-AMERICANS Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Heart Failure and Cardiomyopathies: Heart Failure Is Just a Revolving Door Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy Presentation Number: 1293-246 Authors: Adebayo Atanda, Julius Ngwa, Otelio Randall, Howard University Hospital, Washington, DC, USA
Background: Beta blockers (BB) are well established drugs in management of hypertension. We aim to compare effects of two BB Metoprolol and Nebivolol, a third generation BB with vasodilatory property mediated by nitric oxide release, on blood pressure (BP) control.
Methods: This is a prospective, double-blind, randomized, two arms trial. We randomly assigned 101 African Americans (AA), age 18 to 80 with treated or untreated Stage I hypertension, i.e.140-159/90-99 mmHg to one of two treatment groups A or B, for 16 weeks. Concomitant antihypertensive therapy was permitted. Treatment started with Dose 1 (5 mg Nebivolol or 50 mg metoprolol succinate), then titrated to Dose 2 (double Dose 1) or Dose 3 (double Dose 2) during the scheduled visit depending on office BP response to dose 1 or 2. Subjects proceeded sequentially with labs, office BP measurements and ECHO. Results: Following 16 weeks of therapy, there was a significant decrease in mean systolic blood pressure of 19.09 mmHg among participants taking treatment A (p < 0.001) and 18.97 mmHg for participants taking treatment B (p < 0.001). The mean diastolic blood pressure was also significantly reduced within the treatment groups with treatment A having reduction of 11.63 mmHg (p < 0.001) and treatment B having a similar reduction of 11.62 mmHg (p < 0.001) after the 16 weeks’ therapy. However, there is no statistically significant differences in the BP reduction between the treatment groups. There was only 1 incident of side effect in each group. Conclusions: Although Nebivolol has been shown to be very effective for reducing BP in hypertensive subjects, this study reveals that there is no difference between nebivolol and metoprolol on office blood pressure control in African-Americans after 16 weeks of therapy. This could be related to impaired endothelial function attributed to reduced endothelial nitric oxide bioavailability in African Americans. Additional studies in stage II hypertensive subjects that allow titration to higher doses are needed as the effects of nebivolol on various receptors are dose dependent.