Open AccessThe Effect of Low‐Dose Carvedilol, Nebivolol, and Metoprolol on Central Arterial Pressure and Its Determinants: A Randomized Clinical Trial
Author(s) -
Studinger Péter,
Tabák Ádám G.,
Chen ChenHuan,
Salvi Paolo,
Othmane Taha E.H.,
Torzsa Péter,
Kapocsi Judit,
Fekete Bertalan C.,
Tislér András
Publication year - 2013
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12210
Subject(s) - medicine , nebivolol , carvedilol , metoprolol , randomized controlled trial , blood pressure , cardiology , heart failure
In this prospective, open‐label, randomized, controlled clinical trial the effects of low‐dose carvedilol, nebivolol, and metoprolol on central arterial pressure and augmentation index ( AI x) and its heart rate–corrected value ( AI x@75) were assessed. 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 AI x were measured with applanation tonometry at baseline and at the end of follow‐up. Analyses were restricted to 60 completers. Central systolic pressure decreased equally in all 3 treatment arms. AI x remained unchanged, while AI x@75 decreased significantly by 5.4%±2.5% in the nebivolol group. According to general linear models, individual change in heart rate was a strong predictor of change in AI x in the carvedilol group ( r 2 =0.23, P =.03) although no similar association was found in the nebivolol group ( r 2 =0.09). The impact of β‐blockers with vasodilator effects on pressure augmentation seems to be different with nebivolol having the largest potential of decreasing AIx@75. While AIx changes associated with carvedilol treatment are strongly driven by heart rate changes, those associated with nebivolol treatment seem to be the result of other mechanisms.