Key result
Combination treatment with nebivolol and valsartan decreased plasma renin activity and aldosterone, with baseline levels correlating with 8-week blood pressure reductions.
Why the study?
Does the combination of nebivolol and valsartan alter plasma renin activity and aldosterone concentration compared to monotherapies in patients with hypertension?
RCT (n=805)
placebo-controlled
randomized
Does the combination of nebivolol and valsartan alter plasma renin activity and aldosterone concentration compared to monotherapies in patients with hypertension?
In patients with hypertension, the combination of nebivolol and valsartan significantly reduces plasma aldosterone, and baseline renin activity correlates with the blood pressure lowering response.
Answers are grounded in this paper and cite their sources.
Baseline renin may predict BP response to nebivolol-valsartan; extends evidence for dual RAAS suppression in hypertension.
After demonstration of the antihypertensive efficacy of the combination of the beta-blocker nebivolol and the angiotensin receptor blocker valsartan in an 8-week, randomized, placebo-controlled trial (N = 4161), we now report the effects of this treatment on the renin-angiotensin-aldosterone system in a substudy (n = 805). Plasma renin activity increased with valsartan (54%-73%) and decreased with nebivolol (51%-65%) and the combination treatment (17%-39%). Plasma aldosterone decreased with individual treatments (valsartan, 11%-22%; nebivolol, 20%-26%), with the largest reduction (35%) observed with maximum combination dose (20 mg nebivolol/320 mg valsartan). Baseline ln(plasma renin activity) correlated with the 8-week reductions in 24-hour systolic and diastolic BP following treatments with the combination (all doses combined, P = .003 and P < .001) and nebivolol (both, P < .001), but not with valsartan. Baseline ln(aldosterone) correlated with 24-hour systolic and diastolic BP reductions following combination treatment only (P < .001 and P = .005). The implications of the renin-angiotensin-aldosterone system effects of this beta blocker-angiotensin receptor blocker combination should be explored further.
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Giles et al. (2015) conducted an RCT in hypertension (n=805). Nebivolol and valsartan combination vs. Placebo, nebivolol alone, and valsartan alone was evaluated on Changes in plasma renin activity and aldosterone concentration, and correlation with blood pressure responses. Combination treatment with nebivolol and valsartan decreased plasma renin activity and aldosterone, with baseline levels correlating with 8-week blood pressure reductions.
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