Do Third-Generation Beta-blockers Have a Role in Hypertension?
There has been concern for some time about the role of beta-blockers as straightforward antihypertensive agents (as opposed to their use for "compelling indications," eg, heart failure or post-myocardial infarction). This concern was further heightened by the results of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), which assessed the "newer" regimen of a calcium channel blocker (CCB) plus or minus an angiotensin-converting enzyme (ACE) inhibitor vs the "traditional" regimen of a beta-blocker plus or minus a diuretic. ASCOT found that with the "new" treatment regimen there was not only significantly greater benefit against cardiovascular events, but also one third less chance of developing new-onset diabetes. This led to widespread suggestions that beta-blockers should be considered as inappropriate for first-line treatment of hypertension.
At the same time, it was also noted that the beta-blocker prescribed in ASCOT, atenolol, while the most widely prescribed, was also one of the oldest of these agents, and the question was thus raised whether the same concerns should apply to the newer generation beta-blockers.
One such agent, nebivolol, a third-generation beta-blocker, is currently under review by the US Food and Drug Administration (FDA) for the treatment of hypertension. The drug differs from other beta-adrenoceptor antagonists in that it combines highly selective beta1-adrenoceptor antagonist properties with nitric oxide (NO)-mediated vasodilatory actions, resulting in beneficial effects on endothelial function. It has been suggested that a NO-potentiating agent such as nebivolol may have an important role in hypertensive populations with reduced endothelial function such as diabetics, African Americans, and those with vascular disease.
It was thus of some interest that data from 3 studies with this new-generation beta-blocker nebivolol were presented at the 2007 American Society of Hypertension (ASH) meeting. Two of the studies demonstrated the blood pressure-lowering effects of nebivolol as long-term therapy, either as monotherapy or in combination with other agents. A third presentation was a pooled analysis of 3 registration trials supporting the blood pressure lowering effects of nebivolol monotherapy in individuals who were hypertensive and obese.
There has been concern for some time about the role of beta-blockers as straightforward antihypertensive agents (as opposed to their use for "compelling indications," eg, heart failure or post-myocardial infarction). This concern was further heightened by the results of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), which assessed the "newer" regimen of a calcium channel blocker (CCB) plus or minus an angiotensin-converting enzyme (ACE) inhibitor vs the "traditional" regimen of a beta-blocker plus or minus a diuretic. ASCOT found that with the "new" treatment regimen there was not only significantly greater benefit against cardiovascular events, but also one third less chance of developing new-onset diabetes. This led to widespread suggestions that beta-blockers should be considered as inappropriate for first-line treatment of hypertension.
At the same time, it was also noted that the beta-blocker prescribed in ASCOT, atenolol, while the most widely prescribed, was also one of the oldest of these agents, and the question was thus raised whether the same concerns should apply to the newer generation beta-blockers.
One such agent, nebivolol, a third-generation beta-blocker, is currently under review by the US Food and Drug Administration (FDA) for the treatment of hypertension. The drug differs from other beta-adrenoceptor antagonists in that it combines highly selective beta1-adrenoceptor antagonist properties with nitric oxide (NO)-mediated vasodilatory actions, resulting in beneficial effects on endothelial function. It has been suggested that a NO-potentiating agent such as nebivolol may have an important role in hypertensive populations with reduced endothelial function such as diabetics, African Americans, and those with vascular disease.
It was thus of some interest that data from 3 studies with this new-generation beta-blocker nebivolol were presented at the 2007 American Society of Hypertension (ASH) meeting. Two of the studies demonstrated the blood pressure-lowering effects of nebivolol as long-term therapy, either as monotherapy or in combination with other agents. A third presentation was a pooled analysis of 3 registration trials supporting the blood pressure lowering effects of nebivolol monotherapy in individuals who were hypertensive and obese.