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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

Time to first occurrence of events (all cause death or hospital admission for a cardiovascular reason – primary endpoint). Flather MD, Shibata MC, Coats AJ et al 2005. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J, 26:215–25. Copyright © 2005. Oxford University Press.
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fig2: Time to first occurrence of events (all cause death or hospital admission for a cardiovascular reason – primary endpoint). Flather MD, Shibata MC, Coats AJ et al 2005. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J, 26:215–25. Copyright © 2005. Oxford University Press.

Mentions: A large, randomized, double-blind, placebo-controlled study (SENIORS study), has assessed the effects of nebivolol on mortality and morbidity in elderly patients ≥70 years with a history of heart failure (Flather et al 2005). Patients were started on a dose of 1.25 mg nebivolol once daily and titrated to a target dose of 10 mg over a mean of seven weeks. Although nebivolol did not significantly reduce mortality, the composite risk of all cause mortality or cardiovascular hospital admission (time to first event) was significantly reduced by 15% with nebivolol compared with placebo (Figure 2). This risk reduction was lower than that seen in previous trials with other beta-blockers (Shibata et al 2001). However, a sub-analysis of data from patients most similar to patients of these earlier trials showed the risk reduction to increase to 27%. Such results indicate that nebivolol has comparable benefits to those of other beta-blockers studied in heart failure. The benefits of treatment appeared after 6 months and the risk reduction increased if treatment was continued. The benefits of beta-blockade were independent of the initial ejection fraction and were observed even in patients with mild left ventricular dysfunction or preserved ventricular function. The vasodilating effects specific to nebivolol may help to improve tolerability in elderly patients with heart failure and support the use of this particular beta-blocker to treat heart failure in an elderly population.


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

Cockcroft J - Vasc Health Risk Manag (2007)

Time to first occurrence of events (all cause death or hospital admission for a cardiovascular reason – primary endpoint). Flather MD, Shibata MC, Coats AJ et al 2005. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J, 26:215–25. Copyright © 2005. Oxford University Press.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Time to first occurrence of events (all cause death or hospital admission for a cardiovascular reason – primary endpoint). Flather MD, Shibata MC, Coats AJ et al 2005. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J, 26:215–25. Copyright © 2005. Oxford University Press.
Mentions: A large, randomized, double-blind, placebo-controlled study (SENIORS study), has assessed the effects of nebivolol on mortality and morbidity in elderly patients ≥70 years with a history of heart failure (Flather et al 2005). Patients were started on a dose of 1.25 mg nebivolol once daily and titrated to a target dose of 10 mg over a mean of seven weeks. Although nebivolol did not significantly reduce mortality, the composite risk of all cause mortality or cardiovascular hospital admission (time to first event) was significantly reduced by 15% with nebivolol compared with placebo (Figure 2). This risk reduction was lower than that seen in previous trials with other beta-blockers (Shibata et al 2001). However, a sub-analysis of data from patients most similar to patients of these earlier trials showed the risk reduction to increase to 27%. Such results indicate that nebivolol has comparable benefits to those of other beta-blockers studied in heart failure. The benefits of treatment appeared after 6 months and the risk reduction increased if treatment was continued. The benefits of beta-blockade were independent of the initial ejection fraction and were observed even in patients with mild left ventricular dysfunction or preserved ventricular function. The vasodilating effects specific to nebivolol may help to improve tolerability in elderly patients with heart failure and support the use of this particular beta-blocker to treat heart failure in an elderly population.

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