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  • Review Article
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Review Article

Role of nebivolol in the control and management of central aortic blood pressure in hypertensive patients

Journal of Human Hypertension volume 31, pages 605–610 (2017)Cite this article

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Abstract

Measurement of blood pressure (BP) using a brachial cuff sphygmomanometer is universally accepted for the diagnosis of hypertension and prediction of cardiovascular diseases. However, brachial systolic BP does not represent actual systolic BP in the central arteries which encounter cardiac load directly. Due to wave amplification from central to peripheral arteries, a significant difference exists between the two. Central BP measurements also account for arterial stiffness, vessel branching and vascular mechanics, unlike brachial BP. Emerging data suggests that hypertension can be diagnosed more accurately by central pressure indices as compared to brachial BP. Various non-invasive techniques are now available to measure central BP indices owing to recent technological advances. Recently, it has been reported that different classes of anti-hypertensive drugs display differential effects on brachial and central BPs. Nebivolol is a cardio-selective beta-blocker which targets central systolic BP and reduces it significantly along with brachial BP. In this article, we will review the current literature to evaluate the role of central BP to diagnose hypertension in detail. We will also assess the clinical evidence to evaluate the role of nebivolol in the management of elevated central systolic BP. Central BP indices offer better estimation of BP in central arteries and should be considered in routine clinical practice. Nebivolol has shown significant reduction in aortic pressure and wave reflection and improvements in endothelial dysfunction and arterial stiffness in hypertensive patients.

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References

  1. World Health Organization. (2013). A global brief on Hypertension: Silent killer, global public health crisis. WHO: Geneva, Switzerland, 2013 http://ish-world.com/downloads/pdf/global_brief_hypertension.pdf (accessed on 18 Feb 2016).

  2. McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB . Central blood pressure: current evidence and clinical importance. Eur Heart J 2014; 35: 1719–1725.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Protogerou AD, Papaioannou TG, Blacher J, Papamichael CM, Lekakis JP, Safar ME . Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target? J Hypertens 2007; 25: 265–272.

    Article  CAS  PubMed  Google Scholar 

  4. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213–1225.

    Article  CAS  PubMed  Google Scholar 

  5. Agabiti-Rosei E, Porteri E, Rizzoni D . Arterial stiffness, hypertension, and rational use of nebivolol. Vasc Health Risk Manag 2009; 5: 353–360.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 2007; 50: 197–203.

    Article  CAS  PubMed  Google Scholar 

  7. Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H et al. Central blood pressure measurements and antihypertensive therapy: a consensus document. Hypertension 2007; 50: 154–160.

    Article  CAS  PubMed  Google Scholar 

  8. Saladini F, Santonastaso M, Mos L, Benetti E, Zanatta N, Maraglino G et al. Isolated systolic hypertension of young-to-middle-age individuals implies a relatively low risk of developing hypertension needing treatment when central blood pressure is low. J Hypertens 2011; 29: 1311–1319.

    CAS  PubMed  Google Scholar 

  9. Wang K-L, Cheng H-M, Chuang S-Y, Spurgeon HA, Ting C-T, Lakatta EG et al. Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? J Hypertens 2009; 27: 461–467.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Pini R, Cavallini MC, Palmieri V, Marchionni N, Di Bari M, Devereux RB et al. Central but not brachial blood pressure predicts cardiovascular events in an unselected geriatric population: the ICARe Dicomano Study. J Am Coll Cardiol 2008; 51: 2432–2439.

    Article  PubMed  Google Scholar 

  11. Wohlfahrt P, Wichterle D, Seidlerová J, Filipovský J, Bruthans J, Adámková V et al. Relation of central and brachial blood pressure to left ventricular hypertrophy. The Czech Post-MONICA Study. J Hum Hypertens 2012; 26: 14–19.

    Article  CAS  PubMed  Google Scholar 

  12. Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S . Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation 1999; 100: 1387–1393.

    Article  CAS  PubMed  Google Scholar 

  13. Saba PS, Roman MJ, Pini R, Spitzer M, Ganau A, Devereux RB . Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects. J Am Coll Cardiol 1993; 22: 1873–1880.

    Article  CAS  PubMed  Google Scholar 

  14. Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C . Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010; 31: 1865–1871.

    Article  PubMed  Google Scholar 

  15. Mitchell GF, Hwang S-J, Vasan RS, Larson MG, Pencina MJ, Hamburg NM et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 2010; 121: 505–511.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006; 113: 664–670.

    Article  PubMed  Google Scholar 

  17. Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA 2012; 308: 875–881.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Chirinos JA, Zambrano JP, Chakko S, Veerani A, Schob A, Willens HJ et al. Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease. Hypertension 2005; 45: 980–985.

    Article  CAS  PubMed  Google Scholar 

  19. London GM, Blacher J, Pannier B, Guérin AP, Marchais SJ, Safar ME . Arterial wave reflections and survival in end-stage renal failure. Hypertension 2001; 38: 434–438.

    Article  CAS  PubMed  Google Scholar 

  20. Safar ME, Blacher J, Pannier B, Guerin AP, Marchais SJ, Guyonvarc’h P-M et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002; 39: 735–738.

    Article  CAS  PubMed  Google Scholar 

  21. DeLoach SS, Appel LJ, Chen J, Joffe MM, Gadegbeku CA, Mohler ER et al. Aortic pulse pressure is associated with carotid IMT in chronic kidney disease: report from Chronic Renal Insufficiency Cohort. Am J Hypertens 2009; 22: 1235–1241.

    Article  PubMed  Google Scholar 

  22. London GM, Asmar RG, O’Rourke MF, Safar ME . Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. J Am Coll Cardiol 2004; 43: 92–99.

    Article  CAS  PubMed  Google Scholar 

  23. Mackenzie IS, McEniery CM, Dhakam Z, Brown MJ, Cockcroft JR, Wilkinson IB . Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension. Hypertension 2009; 54: 409–413.

    Article  CAS  PubMed  Google Scholar 

  24. Morgan T, Lauri J, Bertram D, Anderson A . Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens 2004; 17: 118–123.

    Article  CAS  PubMed  Google Scholar 

  25. Manisty CH, Hughes AD . Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2013; 75: 79–92.

    Article  CAS  PubMed  Google Scholar 

  26. Trudeau L . Central blood pressure as an index of antihypertensive control: determinants and potential value. Can J Cardiol 2014; 30: S23–S28.

    Article  PubMed  Google Scholar 

  27. Polónia J, Barbosa L, Silva JA, Bertoquini S . Different patterns of peripheral versus central blood pressure in hypertensive patients treated with β-blockers either with or without vasodilator properties or with angiotensin receptor blockers. Blood Press Monit 2010; 15: 235–239.

    Article  PubMed  Google Scholar 

  28. Soanker R, Naidu MUR, Raju SB, Prasad AK, Rao TRK . Effect of beta-1-blocker, nebivolol, on central aortic pressure and arterial stiffness in patients with essential hypertension. Indian J Pharmacol 2012; 44: 407–411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kampus P, Serg M, Kals J, Zagura M, Muda P, Karu K et al. Differential effects of nebivolol and metoprolol on central aortic pressure and left ventricular wall thickness. Hypertension 2011; 57: 1122–1128.

    Article  CAS  PubMed  Google Scholar 

  30. Davis JT, Pasha DN, Khandrika S, Fung MM, Milic M, O’Connor DT . Central hemodynamics in prehypertension: effect of the β-adrenergic antagonist nebivolol. J Clin Hypertens (Greenwich) 2013; 15: 69–74.

    Article  CAS  Google Scholar 

  31. Dhakam Z, Yasmin, McEniery CM, Burton T, Brown MJ, Wilkinson IB . A comparison of atenolol and nebivolol in isolated systolic hypertension. J Hypertens 2008; 26: 351–356.

    Article  CAS  PubMed  Google Scholar 

  32. Cağlar N, Dincer I . Comparison between nebivolol and ramipril in patients with hypertension and left ventricular hypertrophy: a randomized open blinded end-point (PROBE) trial. Eur Rev Med Pharmacol Sci 2011; 15: 1359–1368.

    PubMed  Google Scholar 

  33. Mahmud A, Feely J . Beta-blockers reduce aortic stiffness in hypertension but nebivolol, not atenolol, reduces wave reflection. Am J Hypertens 2008; 21: 663–667.

    Article  CAS  PubMed  Google Scholar 

  34. Arosio E, De Marchi S, Prior M, Zannoni M, Lechi A . Effects of nebivolol and atenolol on small arteries and microcirculatory endothelium-dependent dilation in hypertensive patients undergoing isometric stress. J Hypertens 2002; 20: 1793–1797.

    Article  CAS  PubMed  Google Scholar 

  35. van Merode T, van Bortel LM, Smeets FA, Mooij JM, Bohm RO, Rahn KH et al. Verapamil and nebivolol improve carotid artery distensibility in hypertensive patients. J Hypertens Suppl 1989; 7: S262–S263.

    Article  CAS  PubMed  Google Scholar 

  36. Hayek SS, Poole JC, Neuman R, Morris AA, Khayata M, Kavtaradze N et al. Differential effects of nebivolol and metoprolol on arterial stiffness, circulating progenitor cells, and oxidative stress. J Am Soc Hypertens 2015; 9: 206–213.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Mediche e Chirurgiche, Cattedra di Medicina Interna, Università di Bologna, Ospedale Policlinico, S.Orsola-Malpighi, Via Albertoni 15, Bologna, Italy

    C Borghi

  2. College of Medicine, University of South Alabama, Mobile, AL, USA

    M C Acelajado

  3. Research and Clinical Services, SPRIM Asia Pacific Pvt. Ltd., Singapore, Singapore

    Y Gupta & S Jain

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  1. C Borghi
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  2. M C Acelajado
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  4. S Jain
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Corresponding author

Correspondence to S Jain.

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Competing interests

This Publication was sponsored by A. Menarini Asia Pacific Pte Ltd. Clinical Authors have received an honorarium for the development and manuscript writing.

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Borghi, C., Acelajado, M., Gupta, Y. et al. Role of nebivolol in the control and management of central aortic blood pressure in hypertensive patients. J Hum Hypertens 31, 605–610 (2017). https://doi.org/10.1038/jhh.2017.26

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  • DOI: https://doi.org/10.1038/jhh.2017.26

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