Abstract 15916: Cardiovascular Outcomes With Nebivolol, Atenolol and Metoprolol in Patients With Hypertension: A Large Retrospective Cohort Study
Introduction: Hypertension is a key risk factor for cardiovascular (CV) events leading to hospitalization. Treatment with a β-blocker can reduce CV risk, but little is known of the comparative effectiveness of nebivolol—a vasodilatory β1-selective antagonist/β3 agonist—and the non-vasodilatory β1-selective blockers atenolol and metoprolol.
Hypothesis: To compare CV event risk leading to hospitalization in hypertensive patients receiving nebivolol, atenolol or metoprolol monotherapy.
Methods: From US national-level claims data (2007-2014), incident users of nebivolol (N=29,300; mean dose=7.4mg/d), atenolol (N=58,279; mean dose=44.8mg/d) or metoprolol (N=97,795; mean dose=56.4mg/d) monotherapy were identified. The first β-blocker claim on or after 1/1/2008 defined the index drug and index date. Hypertensive patients were followed until discontinuation (>90d gap) of the index drug or use of other β-blockers. Patients with pre-index CV history other than hypertension or use of other antihypertensive drugs during follow-up were excluded. Time to first hospital claim for a CV event was assessed by the Cox proportional hazards regression, adjusted for drug duration and baseline demographics, comorbidities, and antihypertensive drug use.
Results: Nebivolol users were younger than atenolol or metoprolol users (mean age: 49.0, 51.3, 51.4y, respectively), a greater proportion were male (54.3% vs 43.8%, 45.5%), and they had fewer baseline comorbid conditions (mean Charlson Comorbidity Index: 1.4 vs 1.5, 1.6). After adjustment, metoprolol and atenolol users had a 111% and 84% greater risk for a composite of hospitalized CV events (MI, CHF, stroke, and angina) vs nebivolol. Risks for component events were also lower with nebivolol (Figure).
Conclusion: In this large retrospective cohort study of hypertensive patients, monotherapy treatment with nebivolol was associated with lower risk of CV events leading to hospitalization vs atenolol and metoprolol.
Author Disclosures: A. Gradman: None. Q. Li: None. S. Ali: Employment; Significant; Allergan plc. M. Patel: Employment; Significant; Allergan plc. J. Basile: Research Grant; Modest; NHLBI (SPRINT),ReCor (RADIANCE). Speakers Bureau; Modest; Amgen, Arbor, Janssen. Consultant/Advisory Board; Modest; Actavis, Amgen, Arbor, Eli-Lilly, Janssen, Medtronic, Recor, Up-to- Date (Hypertension section).
- © 2016 by American Heart Association, Inc.