Abstract 14419: Effect of Nebivolol or Atenolol versus Placebo on Cardiovascular Health in Subjects With Borderline Blood Pressure: The EVIDENCE Study
Introduction: Identifying individuals with early markers for cardiovascular disease (CVD) raises the possibility for pharmacotherapy to slow progression of CVD. Among betablockers nebivolol (NEB) in contrast to atenolol (ATE) has claimed to have beneficial effects on endothelial function.
Hypothesis: NEB slows progression of early CVD more than ATE in subjects free of overt CVD with borderline BP.
Methods: 60 asymptomatic subjects (age range, 18-80 years) with borderline BP and abnormal small artery elasticity underwent a panel of 10 tests measuring large and small artery elasticity, resting and treadmill exercise BP, carotid IMT, retinal vascular photography, micro-albuminuria, ECG, echocardiogram and plasma NT-proBNP. Each test was 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 in parallel to receive placebo (PLAC, n=22), NEB 5/10 mg/d (n=20), ATE 25/50 mg/d (N=18) once daily for 9 months. A panel of these 10 tests was performed at baseline and after 9 months of treatment. The DS was compared at baseline and after 9 months PLAC, NEB and ATE in each group and between the 3 groups.
Results: After 9 months the mean (standard deviation) DS decreased from baseline DS 4.3 (2.6) in the NEB group to 2.8 (2.4) (P < 0.007), in the ATE group DS decreased from 5.4 (2.5) to 3.5 (1.9) (p = 0.0006), while in the PLAC group DS changed from 5.2 (3.0) to 4.5 (2.6) (P = 0.18). Small artery elasticity increased from 6.0 (2.2) to 8.4 (3.4) ml/mmHgx100 (P = 0.0001) in the NEB group and from 6.1 (2.6) to 7.1 (3.0) ml/mmHgx100 in the ATE group (P = 0.063), with no change in PLAC group. Blood pressure decrease was similar in the NEB and ATE group.
Conclusions: Nebivolol is more effective than atenolol in improving small artery elasticity, a measure of endothelial dysfunction. These data suggest that nebivolol, by virtue of its favorable effects on endothelial function, may slow progression of cardiovascular disease in asymptomatic subjects with borderline blood pressure more effectively than atenolol, despite their equal blood pressure lowering effect.
- Blood pressure
- Cardiovascular health
- Cardiovascular disease prevention
- Endothelial function
Author Disclosures: D. Duprez: None. N. Florea: None. C. Koukol: None. S. Duval: None. J.N. Cohn: Research Grant; Modest; Forest Laboratories. Ownership Interest; Modest; Cohn Prevention Centers.
- © 2016 by American Heart Association, Inc.