Effects of Nebivolol on Aortic Compliance in Patients With Diabetes and Maximal Renin Angiotensin System Blockade: The EFFORT Study

Authors

  • Alexandros Briasoulis MD,

    1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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  • Raymond Oliva MD,

    1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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  • Rigas Kalaitzidis MD,

    1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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  • Colleen Flynn MD,

    1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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  • Ivana Lazich MD,

    1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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  • Carrie Schlaffer BS,

    1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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  • George Bakris MD

    Corresponding author
    • Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL
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Address for Correspondence: George Bakris, MD, 5841 S. Maryland Ave. MC 1027, Chicago, IL 60637, USA

E-mail: gbakris@gmail.com

Abstract

The beneficial effects of nebivolol on arterial stiffness and endothelial dysfunction are well documented in untreated hypertensive patients and differ from nonvasodilatory β-blockers. This study tests the hypothesis that the addition of nebivolol in predominantly African American patients with type 2 diabetes already receiving maximally tolerated doses of renin-angiotensin system (RAS) blockers will further improve large artery compliance. Patients with type 2 diabetes and hypertension on maximal RAS blockade (n=70) were randomized to nebivolol or metoprolol succinate daily. Doses were titrated until systolic blood pressure (SBP) was <130 mm Hg. Radial artery applanation tonometry and pulse wave velocity (PWV) analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits at intervals during a 6-month period. Both metoprolol succinate and nebivolol groups demonstrated reductions in brachial SBP (−8.2±4.3 mm Hg [P=.01] and −7.8±3.7 [P=.002], respectively) and aortic DBP (−2.4±1.8 [P=.039] and −4.0±2.9 mm Hg [P=.013], respectively). Aortic SBP decreased in the nebivolol group only (125.3±8 to 121.6±8.2, P=.025). There were no between group differences in aortic SBP, DBP, augmentation index, or PWV reduction. A significant increase in hemoglobin A1c was observed only in the metoprolol group. In patients with well-controlled type 2 diabetes and hypertension treated with maximally tolerated RAS blockade, nebivolol does not offer significant reductions in aortic BP over metoprolol succinate but maintains a stable metabolic profile.

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