Clinical Effects of Classical and Vasodilator Beta Blockers in Treating Hypertension in Adults: A Systematic Review
,
Abstract
Background: Beta-blockers are preferred anti-hypertensive for patients with compelling indications. Vasodilator beta-blockers are of particular benefit in blood pressure control and other cardio-metabolic components with limited disturbance in metabolic parameters. There is inadequate evidence on the superiority of vasodilator beta-blockers over non-vasodilator beta-blockers in treating hypertension. Therefore, this systematic review aimed to generate evidence on the clinical effects of non-vasodilator and vasodilator beta-blockers in treating hypertension in adultsMethods: We searched articles in English published from January 2000 to January 2020 from the following databases: PubMed/Medline, Web of Science, and Google scholar. We considered the following search query: “clinical effectiveness AND vasodilator beta-blockers AND non-vasodilator beta-blockers AND adult hypertension treatment AND clinical trials”.Results: Nine randomized and controlled trials conducted in 3088 adult hypertensive patients were reviewed. All studies agreed on the comparable antihypertensive efficacy of vasodilating and non-vasodilating beta-blockers. Non-vasodilating beta-blockers significantly reduced heart rate, increased blood glucose, blood cholesterol, and triglycerides. Vasodilator beta-blockers were associated with better cardiometabolic risk reduction, better safety, and oxidative stress reduction.Conclusion: The hypertensive efficacy of vasodilating and non-vasodilating beta-blockers were comparable. Vasodilating beta-blockers were associated with better cardiometabolic risk reduction, better safety profile, and better oxidative stress reduction. However, there is insufficient evidence regarding the superiority of vasodilating and non-vasodilator betablockers. Therefore, it is essential to conduct comprehensive clinical trials by involving different ethnic groups to determine the benefit of vasodilator beta-blockers over non-vasodilators for treating hypertension.
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[DOI:10.1023/A:1026180325278] [PMID]
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[35] Remme WJ, Torp-Pedersen C, Cleland JGF, Poole-Wilson PA, Metra M, Komajda M, et al. Carvedilol protects better against vascular events than metoprolol in heart failure: Results from COMET. J Am Coll Cardiol. 2007; 49(9):963-71. [DOI:10.1016/j.jacc.2006.10.059] [PMID]
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Soc Hypertens. 2011; 5(3):161-5. [DOI:10.1016/j.jash.2010.11.003] [PMID] [PMCID]
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[2] Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Betablockers for hypertension. Cochrane Database Syst Rev. 2017; 1(1): CD002003. [DOI:10.1002/14651858.CD002003.pub5] [PMID] [PMCID]
[3] Wiysonge CS, Volmink J, Opie LH. Beta-blockers and the treatment of hypertension: It is time to move on. Cardiovasc J Afr. 2007; 18(6):351-2. [PMID] [PMCID]
[4] McAlister FA, Wiebe N, Ezekowitz JA, Leung AA, Armstrong PW. Meta-analysis: β-blocker dose, heart rate reduction, and death in patients with heart failure. Ann Intern Med. 2009; 150(11):784-94.[DOI:10.7326/0003-4819-150-11-200906020-00006] [PMID]
[5] Chung J, Han JK, Kim YJ, Kim CJ, Ahn Y, Cho MC, et al. Benefit of vasodilating β-blockers in patients with acute myocardial infarction after percutaneous coronary intervention: Nationwide multicenter cohort study. J Am Heart Assoc. 2017; 6(10):e007063. [DOI:10.1161/JAHA.117.007063] [PMID] [PMCID]
[6] Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018; 71(6):1269-324 [DOI:10.1161/HYP.0000000000000065] [PMID]
[7] Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press. 2018; 27(6):314-40. [DOI:10.1080/08037051.2018.1527177] [PMID]
[8] Pucci G, Giovanna Ranalli M, Battista F, Schillaci G. Effects of β-blockers with and without vasodilating properties on central blood pressure: Systematic review and meta-analysis of randomized trials in hypertension. Hypertension. 2016; 67(2):316-24. [DOI:10.1161/HYPERTENSIONAHA.115.06467] [PMID]
[9] Oliver E, Mayor Jr F, D’Ocon P. [Beta-blockers: Historical perspective and mechanisms of action (Spanish)]. Rev Esp Cardiol (Engl Ed). 2019; 72(10):853-62. [DOI:10.1016/j.recesp.2019.02.023] [PMID]
[10] Toda N. Vasodilating β-adrenoceptor blockers as cardiovascular therapeutics. Pharmacol Ther. 2003; 100(3):215-34. [DOI:10.1016/j.pharmthera.2003.09.001] [PMID]
[11] Fergus IV, Connell KL, Ferdinand KC. A Comparison of vasodilating and non-vasodilating beta-blockers and their effects on cardiometabolic risk. Curr Cardiol Rep. 2015 ;17(6):38. [DOI:10.1007/s11886-015-0592-x] [PMID]
[12] Pedersen ME, Cockcroft JR. The vasodilatory beta-blockers. Curr Hypertens Rep. 2007; 9(4):269-77. [DOI:10.1007/s11906-007-0050-2] [PMID]
[13] Mata-Greenwood E, Chen DB. Racial differences in nitric oxide-dependent vasorelaxation. Reprod Sci. 2008; 15(1):9-25.[DOI:10.1177/1933719107312160] [PMID] [PMCID]
[14] Kalinowski L, Dobrucki IT, Malinski T. Race-specific differences in endothelial function: Predisposition of African Americans to vascular diseases. Circulation. 2004; 109(21):2511-7. [DOI:10.1161/01.CIR.0000129087.81352.7A] [PMID]
[15] Mason RP, Kalinowski L, Jacob RF, Jacoby AM, Malinski T. Nebivolol reduces nitroxidative stress and restores nitric oxide bioavailability in endothelium of black Americans. Circulation. 2005; 112(24):3795-801.[DOI:10.1161/CIRCULATIONAHA.105.556233] [PMID]
[16] Van Bortel LM, Fici F, Mascagni F. Efficacy and tolerability of nebivolol compared with other antihypertensive drugs: A meta-analysis. Am J Cardiovasc Drugs. 2008; 8(1):35-44. [DOI:10.2165/00129784-200808010-00005] [PMID]
[17] Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4(1):1. [DOI:10.1186/2046-4053-4-1] [PMID] [PMCID]
[18] Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: Systematic review and meta-analysis. JAMA. 2007; 298(2):194-206. [DOI:10.1001/jama.298.2.194] [PMID]
[19] Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998; 51(12):1235-41. [DOI:10.1016/S0895-4356(98)00131-0] [PMID]
[20] Berger VW, Alperson SY. A general framework for the evaluation of clinical trial quality. Rev Recent Clin Trials. 2009; 4(2):79-88. [DO:10.2174/157488709788186021] [PMID] [PMCID]
[21] Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. [DOI:10.1136/bmj.d5928] [PMID] [PMCID]
[22] Badar VA, Hiware SK, Shrivastava MP, Thawani VR, Hardas MM. 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. [DOI:10.4103/0253-7613.83117] [PMID] [PMCID]
[23] Bakris GL, Fonseca V, Katholi RE, McGill JB, Messerli FH, Phillips RA, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: A randomized controlled trial. JAMA. 2004; 292(18):2227-36. [DOI:10.1001/jama.292.18.2227] [PMID]
[24] 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(3):591-6. [DOI:10.1097/01.hjh.0000209993.26057.de] [PMID]
[25] Tuncer M, Guntekin U, Gunes Y, Gumrukcuoglu HA, Eryonucu B. Differential effects of nebivolol and atenolol on transmitral diastolic filling parameters in patients with essential hypertension. Adv Ther. 2008; 25(6):619-26. [DOI:10.1007/s12325-008-0065-3] [PMID]
[26] Czuriga I, Riecansky I, Bodnar J, Fulop T, Kruzsicz V, Kristof E, et al. Comparison of the new cardioselective beta-blocker nebivolol with bisoprolol in hypertension: The Nebivolol, Bisoprolol Multicenter Study (NEBIS). Cardiovasc Drugs Ther. 2003; 17(3):257-63.
[DOI:10.1023/A:1026180325278] [PMID]
[27] Dhakam Z, Yasmin, McEniery CM, Burton T, Brown MJ, Wilkinson IB. A comparison of atenolol and nebivolol in isolated systolic hypertension. J Hypertens. 2008; 26(2):351-6. [DOI:10.1097/HJH.0b013e3282f283c9] [PMID]
[28] Grassi G, Trevano FQ, Facchini A, Toutouzas T, Chanu B, Mancia G. Efficacy and tolerability profile of nebivolol vs atenolol in mildto-moderate essential hypertension: Results of a double-blind randomized multicentre trial. Blood Press. 2003; 12(2):35-40. [DOI:10.1080/08038020310023271] [PMID]
[29] Hussain M, Saeed M, Babar MZM, Atif MA, Akhtar L. Nebivolol attenuates neutrophil lymphocyte ratio: A marker of subclinical inflammation in hypertensive patients. Int J Hypertens. 2017; 2017:7643628. [DOI:10.1155/2017/7643628] [PMID] [PMCID]
[30] Kumar R, Mal K, Begum J, Shaukat F. Comparison of nebivolol and bisoprolol for cardiovascular mortality in hypertensive patients. Cureus. 2019; 11(12):e6453. [DOI:10.7759/cureus.6453] [PMID] [PMCID]
[31] Fonseca V, Sharma PP, Shah M, Deedwania P. Risk of new-onset diabetes mellitus associated with beta-blocker treatment for hypertension. Curr Med Res Opin. 2011; 27(4):799-807. [DOI:10.1185/03007995.2011.555477] [PMID]
[32] Peter P, Martin U, Sharma A, Dunne F. Effect of treatment with nebivolol on parameters of oxidative stress in type 2 diabetics with mild to moderate hypertension. J Clin Pharm Ther. 2006; 31(2):153-9. [DOI:10.1111/j.1365-2710.2006.00718.x] [PMID]
[33] Rizos CV, Elisaf MS. Antihypertensive drugs and glucose metabolism. World J Cardiol. 2014; 6(7):517-30. [DOI:10.4330/wjc. v6.i7.517] [PMID] [PMCID]
[34] Pischon T, Sharma AM. Use of beta‐blockers in obesity hypertension: Potential role of weight gain. Obes Rev. 2001; 2(4):275-80. [DOI:10.1046/j.1467-789X.2001.00044.x] [PMID]
[35] Remme WJ, Torp-Pedersen C, Cleland JGF, Poole-Wilson PA, Metra M, Komajda M, et al. Carvedilol protects better against vascular events than metoprolol in heart failure: Results from COMET. J Am Coll Cardiol. 2007; 49(9):963-71. [DOI:10.1016/j.jacc.2006.10.059] [PMID]
[36] Kandavar R, Higashi Y, Chen W, Blackstock C, Vaughn C, Sukhanov S, et al. The effect of nebivolol versus metoprolol succinate extended release on asymmetric dimethylarginine in hypertension. J Am
Soc Hypertens. 2011; 5(3):161-5. [DOI:10.1016/j.jash.2010.11.003] [PMID] [PMCID]
[37] Martsevich SY, Kutishenko NP, Deev AD, Oganov RG, Shalnova SA. Comparision of antyhypertensive and metabolic effects of carvedilol and metaprolol in hypertensive patients with overweight and obesity. Camellia trial. L: PP. 34.365. J Hypertens. 2010; 28:e560. [DOI:10.1097/01.hjh.0000379903.65877.a7]
[38] Simova II, Todorova-Konstantinova RR, Denchev SV. Effects of nebivolol versus bisoprolol on endothelial function in hypertensive patients. Exp Clin Cardiol. 2009; 14(4):45-9. [PMID] [PMCID]
[39] Stauffer BL, Dow CA, Diehl KJ, Bammert TD, Greiner JJ, DeSouza CA. Nebivolol, but not metoprolol, treatment improves endothelial fibrinolytic capacity in adults with elevated blood pressure. J Am Heart Assoc. 2017; 6(11):e007437. [DOI:10.1161/JAHA.117.007437] [PMID] [PMCID]
[40] Egan B, Gradman A, Ali S, Li Q, Patel M, Basile J. Cardiovascular outcomes with nebivolol, atenolol and metoprolol in patients with hypertension: A large, retrospective, propensity score-matched cohort study. J Am Coll Cardiol. 2017; 69(11):1691. [DOI:10.1016/S0735-1097(17)35080-5]
[41] Basile J, Egan B, Punzi H, Ali S, Li Q, Patel M, et al. Risk of hospitalization for cardiovascular events with β-blockers in hypertensive patients: A retrospective cohort study. Cardiol Ther. 2018; 7(2):173-83. [DOI:10.1007/s40119-018-0117-y] [PMID] [PMCID]
[42] Merchant N, Rahman ST, Ferdinand KC, Haque T, Umpierrez GE, Khan BV. Effects of Nebivolol In Obese African Americans With Hypertension (NOAAH): Markers of inflammation and obesity in response to exercise-induced stress. J Hum Hypertens. 2011; 25(3):196-202. [DOI:10.1038/jhh.2010.39] [PMID]
[43] Chen S, Swallow E, Jarvis J, Ohashi E, Kelley C, Xie J, et al. Cost impact of switching from metoprolol to nebivolol for hypertension. Am J Pharm Benefits. 2016; 8(3):E48-54. https://scholar.harvard.edu/ckgeiger/publications/cost-impact-switching-metoprolol-nebivolol-hypertension
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| Files | ||
| Issue | Vol 7 No 1/2 (2021) | |
| Section | Review Article(s) | |
| Keywords | ||
| Clinical Effectiveness Non-vasodilator Beta-blockers Vasodilator Beta-blockers Hypertension Systematic Review | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sorato M, Davari M, Fatemi B. Clinical Effects of Classical and Vasodilator Beta Blockers in Treating Hypertension in Adults: A Systematic Review. JPPM. 2021;7(1/2):19-35.
