A comparative study of effects of nebivolol and atenolol on blood pressure and lipid profile in patients of mild to moderate hypertension
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20183018Keywords:
Atenolol, Beta-blockers, Lipid profile, NebivololAbstract
Background: Beta blockers have been used in the treatment of hypertension, since last four decades and are widely accepted as the first-line treatment for hypertension. Nebivolol, a third generation β-blocker has highest β1 selectivity and is devoid of intrinsic sympathomimetic activity. Along with peripheral vasodilatation and nitric oxide (NO)-induced benefits such as antioxidant activity and reversal of endothelial dysfunction, nebivolol promotes better protection from cardiovascular events. The objective of the study was to compare the effects of atenolol and nebivolol on both blood pressure and lipid profile in patients of mild to moderate hypertension.
Methods: This was a prospective, randomized, parallel, open labelled study. Patients were recruited from the medicine out-patient department (OPD) and cardiology OPD. A total of 100 patients were enrolled in the study. 50 patients were allocated to atenolol group and 50 patients to nebivolol group. BP and baseline investigations such as lipid profile were performed. Tests to determine lipid profile were performed on the first visit (Week 0) and at 24 weeks. Continuous variables between the two treatment groups were analyzed by unpaired t-test. Efficacy endpoints within the group were analyzed by using paired t-test.
Results: All the lipid levels except HDL-C were increased with atenolol therapy. At 24 weeks, atenolol therapy led to increase in LDL-C, VLDL-C, TC and TG which was highly significant (p<0.0001). HDL levels were decreased at 24 weeks which was also statistically highly significant (p<0.0001). The mean values of lipids in nebivolol group at baseline and at 24 weeks. At 24 weeks, nebivolol therapy led to changes in LDL-C, VLDL-C, HDL-C, TC and TG which was not statistically significant (p>0.05).
Conclusions: From study it can be concluded that atenolol and nebivolol are equally effective in reducing BP but atenolol worsens lipid profile as compared to nebivolol.
References
Murray CJ, Lopez AD. Evidence-based health policy--lessons from the global burden of disease study. Science. 1996;274(5288):740-3.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60.
Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, et al. Chronic diseases and injuries in India. Lancet. 2011;377(9763):413-28.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden hypertension: Analysis of worldwide data. Lancet. 2005;365:217-23.
Hoffman BB. Therapy of Hypertension. In: Bruton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York: Mcgraw-Hill; 2006:845-850.
Gallup G, Cotugno HE. Preferences and practices of America and their physicians in antihypertensive therapy. Am J Med. 1986;81(6c):20.
Fisher ND, Williams GH. Hypertensive Vascular Disease. In: Kasper DL, Braunwald, Fauci, Hauser, Longo, Jameson, editors. Harrison's Principles of Internal Medicine. 16th ed. New York: Mcgraw-Hill; 2005:1463-1480.
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997 Nov 24;157(21):2413-46.
Wolinsky H. The effects of Beta-Adrenergic blocking agents on blood lipid levels. Clin Cardiol. 1987;10(10):561-6.
Dawes M, Brett SE, Chowienczyk PJ, Mant TG, Ritter JM. The vasodilator action of nebivolol in forearm vasculature of subjects with essential hypertension. Br J Clin Pharmacol. 1999;48:460-3.
Jeffers TA, Webster J, Petrie JC, Barker NP. Atenolol once-daily in hypertension. British Journal of Clinical Pharmacology. 1977;4(5):523-7.
Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet. 2004;364(9446):1684-9.
Aberg H, Morlin C, Lithell H. Different Long term metabolic effects of enalapril and atenolol in patients with mild hypertension EGTA group. J Hum Hypertens. 1995;9(2):149-53.
Libby P. Hypertensive Vascular Disease. In: Kasper DL, Braunwald, Fauci, Hauser, Longo, Jameson, editors. Harrisons’s Principles of Internal Medicine. 17th ed. New York: Mcgraw-Hill; 2008:1505-1506.
Dalal JJ, Padmanabhan TNC, Jain P, Patil S, Vasnawala H, Gulati A. LIPITENSION: Interplay between dyslipidemia and hypertension. Indian J Endocrinol Metab. 2012;16(2):240-5.
Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. J Am Stat Assoc. 1991;86(416):1149.
Kokiwar PR, Gupta SS. Prevalence of hypertension in a rural community of central India. Int J Biol Med Res. 2011;2(4):950-3.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499-502.
Badar VA, Hiware SK, Shrivastava MP, Thawani VR, Hardas MM. A comparison of nebivolol and atenolol on blood pressure, blood sugar, and lipid profile in patients of essential hypertension. Indian J Pharmacol. 2011;43(4):437-40.
Pasini AF, Garbin U, Nava MC, Stranieri C, Davoli A, Sawamura T. Nebivolol decreases oxidative stress in essential hypertensive patients and increases nitric oxide by reducing its oxidative inactivation. J Hypertens. 2005;23:589-96.
Celik T, Iyisoy A, Kursaklioglu H, Kardesoglu E, Kilic S, Turhan H, et al. Comparative effects of nebivolol and metoprolol on oxidative stress, insulin resistance, plasma adiponectin and soluble P-selectin levels in hypertensive patients. J Hypertens. 2006;24:591-6.
Bhosale V, Inamdar S, Karande VB, Burute SR, Murthy MB, Ghatak A. Beneficial Effects of Nebivolol in Comparison with Atenolol on Safety and Tolerability in Essential Hypertension. J Clin Diagnostic Res. 2014;8(6):10-3.
Van Nueten L, Taylor FR, Robertson JI. Nebivolol vs atenolol and placebo in essential hypertension: a double-blind randomised trial. J Hum Hypertens. 12(2):135-40.
Dhakam Z, Yasmin, McEniery CM, Burton T, Brown MJ, Wilkinson IB. A comparison of atenolol and nebivolol in isolated systolic hypertension. J Hypertens. 2008 Feb;26(2):351-6.
Sivaji K, Benerji GV, Farid M, Rekha D. Effect of beta blocker - atenolol on lipid profile in hypertensive patients. Indian J Basic Appl Med Res. 2015;4(4):38-45.
Sahana GN, Sarala N, Kumar TN, Lakshmaiah V. A comparative study of nebivolol and (S) atenolol on blood pressure and heart rate on essential hypertensive patients. Indian J Pharmacol. 2010;42(6):401-5.
Fogari R, Zoppi A, Lazzari P, Mugellini A, Lusardi P, Preti P et al. Comparative effects of nebivolol and atenolol on blood pressure and insulin sensitivity in hypertensive subjects with type II diabetes. J Hum Hypertens. 1997 Nov;11(11):753-7.
Salve P, Khanwelkar C. Effects of Cardio selective Beta Blocker Nebivolol on Different Biochemical Parameters in Essential Hypertensive Patients. Indian Medical Gazette. 2012 Oct;145(10):400-4.
