The Effect of Nebivolol and Atenolol on Renal and Systemic Haemodynamics in Hypertensive Patients

• Published in: High blood pressure & cardiovascular prevention 2007, Vol.14 (3), p.133-137
• Main Authors: van de Borne, Philippe, Fici, Francesco, Makel, Wim, Fiasse, Annette, Degaute, Jean-Paul, Leeman, Marc
• Format: Article
• Language: English
• Subjects: Antihypertensives; Blood pressure; Cardiovascular disease; Drug dosages; Heart rate; Hemodynamics; Hypertension; Statistical analysis
• ISSN: 1120-9879; 1179-1985
• DOI: 10.2165/00151642-200714030-00004

Objectives: Nebivolol is a selective [β.sub.1]-adrenoceptor antagonist with endothelium-mediated vasodilating properties. The effects of nebivolol on renal haemodyamics are unknown in humans. We tested the hypothesis that nebivolol prevents reductions in renal blood flow (RBF), compared with atenolol, in patients with essential uncomplicated hypertension. Methods: The effects of nebivolol (5 mg/day) and atenolol (50 mg/day) on blood pressure, renal and systemic haemodynamics were compared using a crossover, randomised, double-blind study design (n = 10). Cardiac output was determined by Doppler echocardiography. RBF and glomerular filtration rate (GFR) were determined by constant infusion techniques (iodohippurate and Cr-labelled ethylenediaminetetraacetic acid, respectively). All parameters were measured at baseline and again at 1 and 2 hours after an intravenous infusion of N(G)-monomethyl-L-arginine (L-NMMA, 3 mg/kg followed by 3 mg/kg/hour). Results: Both drugs similarly reduced blood pressure. RBF did not change with nebivolol (+3 ± 3%, p = not significant vs baseline), but decreased with atenolol (-13 ± 6%, p < 0.05 vs baseline and p = 0.01 vs changes with nebivolol). GFR decreased by -7 ± 7% with nebivolol (p = not significant vs baseline) and by -18 ± 5% with atenolol (p < 0.01 vs baseline, but p = not significant vs changes with nebivolol). Cardiac output decreased not significantly by -0.17 ± 0.14 L/min with nebivolol and decreased by -0.91 ± 0.22 L/min with atenolol (p < 0.01 vs baseline and p < 0.01 vs changes with nebivolol). RBF and GFR remained larger under nebivolol, respectively, after 1 and 2 hours of L-NMMA infusion (both p < 0.05 vs atenolol). Conclusions: Nebivolol preserves RBF, GFR and cardiac output, compared with atenolol. This may involve other mechanisms besides the L-arginine/nitric oxide pathway. Received for publication 15 May 2007; accepted for publication 2 July 2007. Key words: renal blood flow, glomerular filtration rate, antihypertensive treatment, nebivolol, atenolol.