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A review of the safety and efficacy of nebivolol in the mildly hypertensive patient.

Cockcroft J - Vasc Health Risk Manag (2007)

Bottom Line: The effects of nebivolol have been compared with other beta-blockers and also with other classes of antihypertensive agents.Decreased arterial stiffness has beneficial hemodynamic effects including reductions in central aortic blood pressure.Unlike first generation beta-blockerrs, vasodilator beta-blockerrs such as nebivolol have favorable hemodynamic effects, which may translate into improved cardiovascular outcomes in patients with hypertension.

View Article: PubMed Central - PubMed

Affiliation: Wales Heart Research Institute, University Hospital Heath Park, Cardiff, UK. cockcroftjr@cardiff.ac.uk

ABSTRACT
Nebivolol is a third generation beta-blocker, which can be distinguished from other beta-blockers by its hemodynamic profile. It combines beta-adrenergic blocking activity with a vasodilating effect mediated by the endothelial L-arginine nitric oxide (NO) pathway. The effects of nebivolol have been compared with other beta-blockers and also with other classes of antihypertensive agents. In general, response rates to treatment are higher, and the frequency and severity of adverse events are either comparable or lower with nebivolol. Nebivolol is also effective in reducing cardiovascular morbidity and mortality in elderly patients with heart failure, regardless of the initial ejection fraction. Endothelium-derived NO is important in the regulation of large arterial stiffness, which in turn is a major risk factor for cardiovascular disease. Treatment with nebivolol increases the release of NO from the endothelium and improves endothelial function, leading to a reduction in arterial stiffness. Decreased arterial stiffness has beneficial hemodynamic effects including reductions in central aortic blood pressure. Unlike first generation beta-blockerrs, vasodilator beta-blockerrs such as nebivolol have favorable hemodynamic effects, which may translate into improved cardiovascular outcomes in patients with hypertension.

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Related in: MedlinePlus

Pathophysiological pathways through which aortic stiffness may contribute to the development of diastolic dysfunction. DBP, diastolic blood pressure; SBP, systolic blood pressure. Reproduced with permission from Mottram PM, Haluska BA, Leano R et al 2005. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart, 91:1551–6. Copyright © 2005. BMJ Publishing Group Ltd.
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fig1: Pathophysiological pathways through which aortic stiffness may contribute to the development of diastolic dysfunction. DBP, diastolic blood pressure; SBP, systolic blood pressure. Reproduced with permission from Mottram PM, Haluska BA, Leano R et al 2005. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart, 91:1551–6. Copyright © 2005. BMJ Publishing Group Ltd.

Mentions: Arterial stiffness is a consequence of age (Kass 2002) and also of conditions such as diabetes and hypercholesterolemia, which cause premature vascular aging. Arterial stiffness is a major risk factor for cardiovascular disease and is an important predictor of mortality in hypertensive patients (Laurent et al 2001). Increased aortic stiffness is also an independent predictor of diastolic dysfunction in patients with hypertensive heart disease (Yambe et al 2004; Mottram et al 2005) (see also Figure 1), and may also limit exercise tolerance in patients with dilated cardiomyopathy (Bonapace et al 2003). Patients who have heart failure with a preserved ejection fraction present with ventricular-systolic and arterial stiffening beyond that expected with age and/or hypertension (Kawaguchi et al 2003). Ventricular-vascular stiffening may also be greater in elderly women compared with elderly men (Redfield et al 2005). Therefore, therapies aimed at reducing arterial stiffening may be of use in the treatment of diastolic dysfunction and heart failure.


A review of the safety and efficacy of nebivolol in the mildly hypertensive patient.

Cockcroft J - Vasc Health Risk Manag (2007)

Pathophysiological pathways through which aortic stiffness may contribute to the development of diastolic dysfunction. DBP, diastolic blood pressure; SBP, systolic blood pressure. Reproduced with permission from Mottram PM, Haluska BA, Leano R et al 2005. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart, 91:1551–6. Copyright © 2005. BMJ Publishing Group Ltd.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2350132&req=5

fig1: Pathophysiological pathways through which aortic stiffness may contribute to the development of diastolic dysfunction. DBP, diastolic blood pressure; SBP, systolic blood pressure. Reproduced with permission from Mottram PM, Haluska BA, Leano R et al 2005. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart, 91:1551–6. Copyright © 2005. BMJ Publishing Group Ltd.
Mentions: Arterial stiffness is a consequence of age (Kass 2002) and also of conditions such as diabetes and hypercholesterolemia, which cause premature vascular aging. Arterial stiffness is a major risk factor for cardiovascular disease and is an important predictor of mortality in hypertensive patients (Laurent et al 2001). Increased aortic stiffness is also an independent predictor of diastolic dysfunction in patients with hypertensive heart disease (Yambe et al 2004; Mottram et al 2005) (see also Figure 1), and may also limit exercise tolerance in patients with dilated cardiomyopathy (Bonapace et al 2003). Patients who have heart failure with a preserved ejection fraction present with ventricular-systolic and arterial stiffening beyond that expected with age and/or hypertension (Kawaguchi et al 2003). Ventricular-vascular stiffening may also be greater in elderly women compared with elderly men (Redfield et al 2005). Therefore, therapies aimed at reducing arterial stiffening may be of use in the treatment of diastolic dysfunction and heart failure.

Bottom Line: The effects of nebivolol have been compared with other beta-blockers and also with other classes of antihypertensive agents.Decreased arterial stiffness has beneficial hemodynamic effects including reductions in central aortic blood pressure.Unlike first generation beta-blockerrs, vasodilator beta-blockerrs such as nebivolol have favorable hemodynamic effects, which may translate into improved cardiovascular outcomes in patients with hypertension.

View Article: PubMed Central - PubMed

Affiliation: Wales Heart Research Institute, University Hospital Heath Park, Cardiff, UK. cockcroftjr@cardiff.ac.uk

ABSTRACT
Nebivolol is a third generation beta-blocker, which can be distinguished from other beta-blockers by its hemodynamic profile. It combines beta-adrenergic blocking activity with a vasodilating effect mediated by the endothelial L-arginine nitric oxide (NO) pathway. The effects of nebivolol have been compared with other beta-blockers and also with other classes of antihypertensive agents. In general, response rates to treatment are higher, and the frequency and severity of adverse events are either comparable or lower with nebivolol. Nebivolol is also effective in reducing cardiovascular morbidity and mortality in elderly patients with heart failure, regardless of the initial ejection fraction. Endothelium-derived NO is important in the regulation of large arterial stiffness, which in turn is a major risk factor for cardiovascular disease. Treatment with nebivolol increases the release of NO from the endothelium and improves endothelial function, leading to a reduction in arterial stiffness. Decreased arterial stiffness has beneficial hemodynamic effects including reductions in central aortic blood pressure. Unlike first generation beta-blockerrs, vasodilator beta-blockerrs such as nebivolol have favorable hemodynamic effects, which may translate into improved cardiovascular outcomes in patients with hypertension.

Show MeSH
Related in: MedlinePlus