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Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study

Journal of Human Hypertension volume 32, pages 20–25 (2018)Cite this article

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Abstract

Pharmacotherapy to protect the arteries may be appropriate for individuals with high-normal blood pressure who are at risk for future cardiovascular disease (CVD). Nebivolol (NEB) in contrast to atenolol (ATE) may have a beneficial effect on endothelial function and may be more effective than ATE in preventing CVD. Sixty subjects with preHTN or borderline BP and abnormal small artery elasticity (SAE) underwent evaluation with 10 tests, including large and small artery elasticity, resting and treadmill exercise BP, carotid intimal-media thickness, retinal vascular photography, micro-albuminuria, electrocardiography, echocardiography, and plasma B-type natriuretic peptide level. Each test scored as normal (0), borderline (1), or abnormal (2), and the total disease score (DS) was calculated by adding the test scores. Subjects were randomized double-blind to placebo (PLAC, n = 22), NEB 5/10 mg/day (n = 20), or ATE 25/50 mg/day (n = 18) once daily for 9 months. After 9 months, in the group receiving NEB the mean (standard deviation) DS decreased from baseline 4.3 (2.6) to 2.8 (2.4) (P < 0.007), with ATE from 5.4 (2.5) to 3.5 (1.9) (P = 0.0006), and with PLAC from 5.2 (3.0) to 4.5 (2.6) (P = 0.18). SAE increased in the NEB group from 6.0 (2.2) to 8.4 (3.4) ml/mmHg × 100 (P = 0.0001), whereas there was no significant change in the ATE and PLAC groups. Thus, nebivolol improves small artery function more than atenolol in asymptomatic subjects with preHTN or borderline BP, despite their similar BP-lowering effect.

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Acknowledgements

The EVIDENCE study was funded by a research grant from FOREST Laboratories. The study design was developed independently from FOREST Laboratories. The EVIDENCE study has been registered in ClinicalTrials.gov as NCT01522950.

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  1. Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, MN, 55455, USA

    Daniel A. Duprez, Natalia Florea, Sue Duval, Catherine Koukol & Jay N. Cohn

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  1. Daniel A. Duprez
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Correspondence to Jay N. Cohn.

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Conflict of interest

Daniel A. Duprez has received research grants from Pfizer, Regeneron, Astra-Zeneca and Novartis. Jay N. Cohn has received a research grant form Forest Laboratories; he is an equity partner in CVC-HD, LLC. The remaining authors declare that they have no competing interests.

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Duprez, D.A., Florea, N., Duval, S. et al. Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study. J Hum Hypertens 32, 20–25 (2018). https://doi.org/10.1038/s41371-017-0019-9

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