Effects of Nebivolol on Aortic Compliance in Patients With Diabetes and Maximal Renin Angiotensin System Blockade: The EFFORT Study
Article first published online: 30 APR 2013
© 2013 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 15, Issue 7, pages 473–479, July 2013
How to Cite
J Clin Hypertens (Greenwich). 2013;15:473–479. ©2013 Wiley Periodicals, Inc
- Issue published online: 1 JUL 2013
- Article first published online: 30 APR 2013
- Manuscript Accepted: 21 MAR 2013
- Manuscript Revised: 18 MAR 2013
- Manuscript Received: 4 FEB 2013
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.