title: The effect of low-dose carvedilol, nebivolol, and metoprolol on central arterial pressure and its determinants: a randomized clinical trial.
abstract: In this prospective, open-label, randomized, controlled clinical trial the effects of low-dose carvedilol, nebivolol, and metoprolol on central arterial pressure and augmentation index (AIx) and its heart rate-corrected value (AIx@75) were assessed. The authors randomized 75 hypertensive patients (18-70 years) to carvedilol 12.5/25 mg, metoprolol 50/100 mg, or nebivolol 2.5/5 mg daily and followed them up for 3 months. Central arterial pressure and AIx were measured with applanation tonometry at baseline and at the end of follow-up. Analyses were restricted to 60 completers. Central systolic pressure decreased equally in all 3 treatment arms. AIx remained unchanged, while AIx@75 decreased significantly by 5.4%±2.5% in the nebivolol group. According to general linear models, individual change in heart rate was a strong predictor of change in AIx in the carvedilol group (r(2) =0.23, P=.03) although no similar association was found in the nebivolol group (r(2) =0.09). The impact of β-blockers with vasodilator effects on pressure augmentation seems to be different with nebivolol having the largest potential of decreasing AIx@75. While AIx changes associated with carvedilol treatment are strongly driven by heart rate changes, those associated with nebivolol treatment seem to be the result of other mechanisms.
authors.affiliation: 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Studinger
authors.forename: Ádám G
authors.initials: ÁG
authors.lastname: Tabák
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
authors.forename: Paolo
authors.initials: P
authors.lastname: Salvi
authors.forename: Taha E H
authors.initials: TE
authors.lastname: Othmane
authors.forename: Péter
authors.initials: P
authors.lastname: Torzsa
authors.forename: Judit
authors.initials: J
authors.lastname: Kapocsi
authors.forename: Bertalan C
authors.initials: BC
authors.lastname: Fekete
authors.forename: András
authors.initials: A
authors.lastname: Tislér
mesh_terms: D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D062186:Arterial Pressure / Q000187:drug effects*; D001578:Benzopyrans / Q000008:administration & dosage / Q000627:therapeutic use*; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D000068577:Nebivolol; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D001578:Benzopyrans; D002227:Carbazoles; D004983:Ethanolamines; D011412:Propanolamines; D000068577:Nebivolol; D000077261:Carvedilol; D008790:Metoprolol