Key result
A 2-week treatment with nebivolol or nifedipine produced similar significant reductions in blood pressure in hypertensive patients with COPD, with only slight impacts on FEV1.
Why the study?
Does nebivolol compared to nifedipine affect pulmonary function and blood pressure in hypertensive patients with mild to moderate COPD?
RCT (n=20)
Single-blind
Does nebivolol compared to nifedipine affect pulmonary function and blood pressure in hypertensive patients with mild to moderate COPD?
A 2-week treatment with nebivolol safely lowers blood pressure similarly to nifedipine in hypertensive patients with mild to moderate COPD, with only slight effects on pulmonary function.
May inform BP treatment choices in hypertensive COPD patients; leaves open need for larger trials on outcomes.
BACKGROUND: It has been suggested that the antihypertensive agent nebivolol, a beta1-adrenoceptor-blocking agent that modulates the endogenous production of nitric oxide, is preferable to 'conventional' beta1-blockers in hypertensive patients with airway dysfunction. OBJECTIVES: Since beta1-blockade by nebivolol is larger after repeated dosing than after a single oral intake, we have explored its effect on pulmonary function after a 2-week treatment in hypertensive patients with mild to moderate COPD. METHODS: A single-blind crossover design was used. Twenty patients with COPD as selected above and with a diastolic blood pressure of 95-110 mm Hg after 1 week of placebo run-in were entered into the two 2-week active treatment periods with either 5 mg nebivolol (n = 10) or 30 mg nifedipine gastrointestinal-transport-system (GITS) (n = 10) taken for a period of 2 weeks. After a further 1-week washout, subjects were crossed-over to receive the other drug for 2 additional weeks. At each visit, changes in spirometric indexes and the interaction with the bronchodilator effect of salbutamol were investigated. Moreover, systolic and diastolic blood pressure (BP) together with heart rate were manually measured in order to evaluate the cardiovascular effects of the different treatments. Throughout the study, patients recorded symptoms. RESULTS: Similar and significant reductions in systolic and diastolic BP were observed with both treatments. The impact of nifedipine on FEV1 was not significant (p > 0.05), while that of nebivolol was slight. The maximum response to salbutamol was slightly decreased with either nebivolol or nifedipine GITS. Day-to-day airway obstruction control, interpreted from patient recordings of symptom scores and inhaler use, was similar with both treatments. CONCLUSIONS: Our pilot study suggests that the use of nebivolol in hypertensive patients with stable mild to moderate COPD was safe during a 2-week trial. Evaluation of longer time periods, larger patient numbers with more severe COPD or during exacerbations is warranted.
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Cazzola et al. (2004) conducted an RCT in Hypertension and mild to moderate COPD (n=20). Nebivolol vs. Nifedipine GITS 30 mg was evaluated on Changes in spirometric indexes, interaction with salbutamol, and blood pressure. A 2-week treatment with nebivolol or nifedipine produced similar significant reductions in blood pressure in hypertensive patients with COPD, with only slight impacts on FEV1.
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