Effects of Nebivolol Versus Metoprolol Succinate on Endothelial Function

The aim of this study was to compare the effects between the vasodilating β-blocker nebivolol and the cardioselective β-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study in 80 hypertensive patients. Patients received either nebivolol 5 mg or metoprolol succinate 50-100 mg daily for one year. Their heart rate, central and brachial blood pressure, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity and left ventricular wall thickness were measured at baseline and at the end of the study.

Inclusion criteria

• Patients with mild to moderate essential hypertension (systolic BP 140-179 mmHg and/or diastolic BP 90-109 mmHg)*
• Male and female patients aged 30-65 years Newly diagnosed untreated patients or previously diagnosed patients who were without treatment at least two weeks prior to screening* If patient has been taken previously antihypertensive medication the BP values are originated after untreated two weeks before randomization

Exclusion criteria

• Concomitant medication: Cyclic antidepressants, MAO inhibitors, corticosteroids
• Diabetes I or II type (fasting venous plasma glucose > 6.4 mmol/l)
• Bronchial asthma and chronic obstructive airway disease
• Body mass index > 30 kg/m2
• Ischaemic heart disease (III, IV stage, Canadian Cardiovascular Society)
• Clinically relevant heart failure (NYHA class II - IV)
• Clinically relevant valve disease (physical examination)
• Arrhythmias and conduction disturbances, requiring therapy, sinus bradycardia at rest < 50 b/min, sick sinus syndrome, AV - block stage II - III
• Secondary hypertension (urea >8.3 mmol/l, creatinine >120μmol/l (males), >103 μmol/l (females), TSH > 4.0mIU/l, free T4 > 27 pmol/l)
• Clinically relevant atherosclerotic disease of lower extremities
• Acute inflammation (according to CRP > 10mg/l)
• Hypercholesterolemia (> 6,5 mmol/l)
• Allergic reaction to beta-blockers
• Pregnant or breast-feeding women
• History of hepatic, renal, metabolic or endocrine diseases
• Smoking > 10 cigarettes per day
• Alcohol consumption > 7 drinks per week (drink = 0,33 l beer, 120 ml wine or 30 ml strong alcoholic drink)
• The patient has had surgery or disease of the gastrointestinal tract which, in the opinion of the investigator, may influence the absorption or elimination of the study drug.
• The patient has a severe organic disorder that may interfere with the absorption, pharmacokinetics, or elimination of the study medication.
• The patient has a comorbid condition that would be expected to result in death during the trial period (e.g., terminal cancer, AIDS).
• The patient has chronic psychoses or behavioural conditions that would limit the ability of the patient to comply with the requirements of this study.
• The patient has known hypersensitivity to Nebivolol, Metoprolol or hydrochlorothiazide related compounds.
• Patient is enrolled in another clinical trial.