Слайд 11First published: 04 October 2013
The Effect of Low‐Dose Carvedilol, Nebivolol, and Metoprolol on
Central Arterial Pressure and Its Determinants.
1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
Department of Epidemiology and Public Health, University College London, London, UK
Abstract
BACKGROUND:
. The authors randomized 75 hypertensive patients (18–70 years) to carvedilol 12.5/25 mg, metoprolol 50/100 mg, or nebivolol 2.5/5 mg daily and followed them up for 3 months. Central arterial pressure and AIx were measured with applanation tonometry at baseline and at the end of follow‐up.
MATERIALS AND METHODS:
Prospective, open‐label, 1:1:1, parallel‐group, randomized, controlled clinical trial. Eighty‐four patients were screened for the study but 9 were not randomized because they did not meet the inclusion criteria or declined to participate. Of the 75 patients randomized and allocated to intervention, 3 patients (2 metoprolol and 1 nebivolol) did not receive the allocated intervention because they favored lifestyle modification over drug treatment after the first hemodynamic measurement. Seven patients were lost to follow‐up (3 metoprolol, 2 nebivolol, and 2 carvedilol), as a result of traveling abroad or declining to return to the second hemodynamic measurement. Five patients discontinued medication because they experienced side effects of dizziness, hypotension or toxicoderma (metoprolol), cold extremities (nebivolol), or erectile dysfunction (carvedilol). Among the 60 patients analyzed, 18 were randomized to metoprolol, 21 to nebivolol, and 21 to carvedilol
RESULTS:
Brachial systolic, mean, and diastolic BPs decreased significantly in all treatment groups, measured either as office BP or as BP taken during hemodynamic data collection. There was no between‐group difference in the degree of BP decrease. Confirming a decrease in BP, 24‐hour BP monitoring was successful in 45 patients (16 in the metoprolol, 18 in the nebivolol, and 11 in the carvedilol groups). In the carvedilol group, however (probably because of the relatively low number of patients), the drop in BP was not statistically significant according to the ABPM measurements. As expected, all drugs reduced heart rate to the same extent in each treatment groups. There was a slight but statistically significant rise in plasma potassium levels in patients taking carvedilol.
CONCLUSIONS:
In the present study, we found similar decreases of central BP irrespective of treatment arm, while no significant alterations in AIx or PWV were found in either of the groups. In contrast to no changes in the carvedilol and the metoprolol groups, heart rate‐adjusted AIx significantly and reflected wave amplitude nonsignificantly decreased in the nebivolol group.