Comparative effects of a two-week treatment with nebivolol and nifedipine in hypertensive patients suffering from COPD.
BACKGROUND
It has been suggested that the antihypertensive agent nebivolol, a beta1-adrenoceptor-blocking agent that modulates the endogenous production of nitric oxide, is preferable to 'conventional' beta1-blockers in hypertensive patients with airway dysfunction.


OBJECTIVE
Since beta1-blockade by nebivolol is larger after repeated dosing than after a single oral intake, we have explored its effect on pulmonary function after a 2-week treatment in hypertensive patients with mild to moderate COPD.


METHODS
A single-blind crossover design was used. Twenty patients with COPD as selected above and with a diastolic blood pressure of 95-110 mm Hg after 1 week of placebo run-in were entered into the two 2-week active treatment periods with either 5 mg nebivolol (n = 10) or 30 mg nifedipine gastrointestinal-transport-system (GITS) (n = 10) taken for a period of 2 weeks. After a further 1-week washout, subjects were crossed-over to receive the other drug for 2 additional weeks. At each visit, changes in spirometric indexes and the interaction with the bronchodilator effect of salbutamol were investigated. Moreover, systolic and diastolic blood pressure (BP) together with heart rate were manually measured in order to evaluate the cardiovascular effects of the different treatments. Throughout the study, patients recorded symptoms.


RESULTS
Similar and significant reductions in systolic and diastolic BP were observed with both treatments. The impact of nifedipine on FEV1 was not significant (p > 0.05), while that of nebivolol was slight. The maximum response to salbutamol was slightly decreased with either nebivolol or nifedipine GITS. Day-to-day airway obstruction control, interpreted from patient recordings of symptom scores and inhaler use, was similar with both treatments.


CONCLUSIONS
Our pilot study suggests that the use of nebivolol in hypertensive patients with stable mild to moderate COPD was safe during a 2-week trial. Evaluation of longer time periods, larger patient numbers with more severe COPD or during exacerbations is warranted.
Cazzola
Mario
M
Unit of Pneumology and Allergology, Department of Pneumology, A. Cardarelli Hospital, Naples, Italy. mcazzola@qubisoft.it
Matera
Maria Gabriella
MG
Ruggeri
Paolo
P
Sanduzzi
Alessandro
A
Spicuzza
Lucia
L
Vatrella
Alessandro
A
Girbino
Giuseppe
G
D000368:Aged; D000420:Albuterol / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001578:Benzopyrans / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D001993:Bronchodilator Agents / Q000627:therapeutic use; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000068577:Nebivolol; D009543:Nifedipine / Q000008:administration & dosage*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014797:Vital Capacity / Q000187:drug effects
D000959:Antihypertensive Agents; D001578:Benzopyrans; D001993:Bronchodilator Agents; D004983:Ethanolamines; D014665:Vasodilator Agents; D000068577:Nebivolol; D009543:Nifedipine; D000420:Albuterol