Sayin M R, Aydin M, Dogan S M, Karabag T, Cetiner M A, Aktop Z
Department of Cardiology, Bülent Ecevit University, Zonguldak, Turkey.
Herz. 2013 May;38(3):299-305. doi: 10.1007/s00059-012-3695-9. Epub 2012 Dec 23.
The aim of this study was to compare the effects of the new generation β-blocker anti-hypertensive drugs carvedilol and nebivolol on aortic elastic properties which are important indicators of hypertension-related morbidity and mortality.
A total of 50 patients who had been diagnosed with stage 1 hypertension according to the Joint National Committee (JNC) VII criteria and who had not received any anti-hypertensive treatment were enrolled in this study. Patients were randomized to receive either 25 mg/day carvedilol (n=25) or 5 mg/day nebivolol (n=25) for 3 months at the beginning of the study. Three patients (1 in the carvedilol group, 2 in the nebivolol group) who did not attend 3 month follow-up measurements were excluded from the study. The study was completed with 47 patients (25 women; mean age: 49 ± 9 years). The aortic elastic parameters such as aortic strain (AS), aortic distensibility (AD), and aortic stiffness index (ASI) were measured by echocardiography.
Carvedilol and nebivolol provided a similar decline in both systolic and diastolic blood pressures (-12/-7 mmHg, p<0.0001 and -12/-7 mmHg, p=0.002, respectively). Both carvedilol and nebivolol induced a significant decrease in heart rate (-15 bpm, p<0.0001, -17 bpm, p<0.0001, respectively). Even though the heart rate at the end of the treatment was lower for the nebivolol group, the rate of decrease of heart rates between carvedilol and nebivolol groups was not statistically significant (p=0.074). Both groups demonstrated improvements in the diastolic functions of the left ventricle where certain values showed more improvement for the nebivolol group. Both groups showed improvements in AS and AD rates compared to basal rates; however, these improvements were not statistically significant. Although the improvement rates in AS, AD, and ASI were higher in the nebivolol group compared to the carvedilol group, the differences were not statistically significant (p=0.091, p=0.095, p=0.259, respectively).
Both carvedilol and nebivolol induced a decrease in blood pressure and heart rate and showed an improvement in left ventricular diastolic functions. It was observed that both drugs did not cause deterioration in the aortic elastic properties but a slight improvement was seen. However, this improvement was not statistically significant. The improvement was more explicit in the nebivolol group. It may be concluded that nebivolol is slightly superior to carvedilol in reducing heart rate and improving left ventricular diastolic functions. However, further long-term studies with larger sample sizes should be performed in order to better define the effects of both drugs.
本研究旨在比较新一代β受体阻滞剂抗高血压药物卡维地洛和奈必洛尔对主动脉弹性特性的影响，主动脉弹性特性是高血压相关发病率和死亡率的重要指标。
根据美国国家联合委员会（JNC）VII标准被诊断为1期高血压且未接受任何抗高血压治疗的50例患者纳入本研究。在研究开始时，患者被随机分为接受25mg/天卡维地洛（n = 25）或5mg/天奈必洛尔（n = 25）治疗3个月。3例未参加3个月随访测量的患者（卡维地洛组1例，奈必洛尔组2例）被排除在研究之外。47例患者（25例女性；平均年龄：49±9岁）完成了研究。通过超声心动图测量主动脉弹性参数，如主动脉应变（AS）、主动脉扩张性（AD）和主动脉僵硬度指数（ASI）。
卡维地洛和奈必洛尔均可使收缩压和舒张压出现相似程度的下降（分别为-12/-7mmHg，p<0.0001和-12/-7mmHg，p = 0.002）。卡维地洛和奈必洛尔均使心率显著降低（分别为-15次/分钟，p<0.0001，-17次/分钟，p<0.0001）。尽管治疗结束时奈必洛尔组的心率较低，但卡维地洛组和奈必洛尔组之间心率下降的速率无统计学意义（p = 0.074）。两组左心室舒张功能均有改善，某些值在奈必洛尔组改善更明显。与基础值相比，两组的AS和AD率均有改善；然而，这些改善无统计学意义。尽管奈必洛尔组的AS、AD和ASI改善率高于卡维地洛组，但差异无统计学意义（分别为p = 0.091，p = 0.095，p = 0.259）。
卡维地洛和奈必洛尔均可降低血压和心率，并改善左心室舒张功能。观察到两种药物均未导致主动脉弹性特性恶化，而是有轻微改善。然而，这种改善无统计学意义。奈必洛尔组的改善更明显。可以得出结论，在降低心率和改善左心室舒张功能方面，奈必洛尔略优于卡维地洛。然而，为了更好地确定两种药物的效果，应进行进一步的大样本长期研究。
