Why the study?
Most patients with hypertension require combination therapy, but beta-adrenergic antagonists and angiotensin II type 1 receptor blockers have been considered less effective together due to overlapping mechanisms of action.
Does nebivolol/valsartan fixed-dose combination improve blood pressure lowering in patients with hypertension compared to monotherapy or placebo?
Does nebivolol/valsartan fixed-dose combination improve blood pressure lowering in patients with hypertension compared to monotherapy or placebo?
While the nebivolol/valsartan combination significantly lowers blood pressure compared to monotherapy and reduces pill burden, it does not offer clinically significant benefits to elevate its routine place in hypertension management.
May support nebivolol/valsartan fixed-dose use in hypertension needing combination therapy; leaves open head-to-head outcome trials.
DATA SOURCES: A PubMed (1966 to October 2018) search was conducted using the following keywords: nebivolol, valsartan, and hypertension (HTN). Additional sources were identified by references. STUDY SELECTION AND DATA EXTRACTION: Articles written in English were included if they evaluated the pharmacology, pharmacokinetics, efficacy, safety, or place in therapy of nebivolol/valsartan in human subjects. DATA SYNTHESIS: Most patients with HTN require combination therapy; however, β-adrenergic antagonists and AII type 1 receptor blockers have been considered less effective because of overlapping mechanisms of action. A phase III, randomized trial demonstrated that nebivolol/valsartan produced statistically significant blood pressure (BP) lowering as compared with monotherapy with the individual components or placebo. Substudy analyses confirmed this among subgroups and demonstrated that nebivolol/valsartan decreased plasma renin and aldosterone levels. One trial reported continued BP lowering at 52 weeks. Another study showed that nebivolol/valsartan had similar additivity scores as compared with other antihypertensive combinations. Relevance to Patient Care and Clinical Practice: This review discusses drug information, efficacy, and safety of nebivolol/valsartan and discusses its clinical relevance as a novel combination product in managing patients with HTN. CONCLUSION: Nebivolol/valsartan combination may offer a benefit to patients with an indication for both classes who desire to decrease pill burden. Although BP lowering was statistically significant in comparison to the individual components as monotherapy, the combination does not offer clinically significant benefits that would elevate its place in HTN management.
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Battise et al. (2018) studied this question.
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