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Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial
Author(s) -
CohenSolal Alain,
Kotecha Dipak,
Veldhuisen Dirk J,
Babalis Daphne,
Böhm Michael,
Coats Andrew J.,
Roughton Michael,
PooleWilson Philip,
Tavazzi Luigi,
Flather Marcus
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp104
Subject(s) - medicine , nebivolol , heart failure , impaired renal function , renal function , cardiology , intensive care medicine , clinical trial , blood pressure
Aim To determine the safety and efficacy of nebivolol in elderly heart failure (HF) patients with renal dysfunction. Methods and results SENIORS recruited patients aged 70 years or older with symptomatic HF, irrespective of ejection fraction, and randomized them to nebivolol or placebo. Patients ( n = 2112) were divided by tertile of estimated glomerular filtration rate (eGFR). Mean age of patients was 76.1 years, 35% of patients had an ejection fraction of >35%, and 37% were women resulting in a unique cohort, far more representative of clinical practice than previous trials. eGFR was strongly associated with outcomes and nebivolol was similarly efficacious across eGFR tertiles. The primary outcome rate (all‐cause mortality or cardiovascular hospital admission) and adjusted hazard ratio for nebivolol use in those with low eGFR was 40% and 0.84 (95% CI 0.67–1.07), 31% and 0.79 (0.60–1.04) in the middle tertile, and 29% and 0.86 (0.65–1.14) in the highest eGFR tertile. There was no interaction noted between renal function and the treatment effect ( P = 0.442). Nebivolol use in patients with moderate renal impairment (eGFR <60) was not associated with major safety concerns, apart from higher rates of drug‐discontinuation due to bradycardia. Conclusion Nebivolol is safe and has a similar effect in elderly HF patients with mild or moderate renal impairment.