title: Effectiveness of nebivolol and hydrochlorothiazide association on blood pressure, glucose, and lipid metabolism in hypertensive patients.
abstract: BACKGROUND
  Only 50% of hypertensive patients receive an appropriate treatment to normalize blood pressure (BP). Although monotherapy is often adequate in normalizing BP, it is sometimes necessary to start with combination therapy. The aim of the study was to evaluate the efficacy of nebivolol alone and in association with hydrochlorothiazide (HCT) in reducing BP in hypertensive patients with new-onset, mild-to-moderate hypertension, and to assess the effect of combination therapy on glucose and lipid metabolism.
  
  
  METHODS
  At enrollment, patients underwent a full cardiovascular and metabolic evaluation. Patients were then prescribed nebivolol (5 mg/day). After 1 month, in those patients whose BP was not normalized, HCT 12.5 mg was added and increased further to 25 mg after 1 month in those whose BP still was not normalized. All patients were assessed at monthly intervals for a further 5 months.
  
  
  RESULTS
  We enrolled 233 treatment-naive patients. After the first month of treatment with nebivolol, 70% of patients had normalized BP. The addition of HCT increased responder rates to 94%. An improvement in glucose metabolism was noted with nebivolol alone (at 1 month, the reduction in Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] was 26% and remained stable at 6 months); the adjunct of HCT blunted the reduction in HOMA-IR. No significant changes on lipid profile were noted with nebivolol, either alone or in combination therapy.
  
  
  CONCLUSIONS
  Nebivolol is effective in mild-to-moderate hypertension and associated with favorable metabolic effects. The addition of HCT optimizes BP control in a high number of patients resistant to monotherapy without a negative impact on patients' glucose and lipid profile.
authors.affiliation: IRCCS San Raffaele Pisana, Via della Pisana, 235 00163 Roma, Italy. giuseppe.marazzi@sanraffaele.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marazzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Volterrani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caminiti
authors.forename: Luigi
authors.initials: L
authors.lastname: Iaia
authors.forename: Luca
authors.initials: L
authors.lastname: Cacciotti
authors.forename: Rosalba
authors.initials: R
authors.lastname: Massaro
authors.forename: Barbara
authors.initials: B
authors.lastname: Sposato
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mercuro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001578:Benzopyrans / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001786:Blood Glucose / Q000187:drug effects; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D006973:Hypertension / Q000188:drug therapy*; D050356:Lipid Metabolism / Q000187:drug effects; D008297:Male; D000068577:Nebivolol
chemical_list: D000959:Antihypertensive Agents; D001578:Benzopyrans; D001786:Blood Glucose; D004983:Ethanolamines; D000068577:Nebivolol; D006852:Hydrochlorothiazide