Why the study?
Does smoking status affect the antihypertensive effectiveness and lung function impact of carvedilol, nebivolol, and amlodipine in patients with arterial hypertension?
RCT (n=130)
randomised
Does smoking status affect the antihypertensive effectiveness and lung function impact of carvedilol, nebivolol, and amlodipine in patients with arterial hypertension?
Amlodipine maintains its antihypertensive efficacy without compromising lung function in smokers with hypertension, making it a preferred first-choice medication over carvedilol and nebivolol in this population.
Amlodipine should be prioritized for hypertensive smokers; extends evidence on smoking-attenuated beta-blocker response.
Aim. To compare antihypertensive effectiveness of carvedilol, nebivolol, and amlodipine in smokers and non-smokers with arterial hypertension (AH).Material and methods. The study included 130 patients with Stage 1–2 AH, aged 30–55 years, who were randomised into three treatment groups: carvedilol (n=56), nebivolol (n=44), and amlodipine (n=30). Each group was also divided into two subgroups of smokers and nonsmokers (never-smokers or ex-smokers who stopped smoking at least one year ago). At baseline and after 8 weeks of the treatment, the dynamics of office blood pressure (BP) levels, parameters of 24-hour BP monitoring, and lung function were compared across the subgroups.Results. After 8 weeks of the treatment, office BP levels reduced significantly and comparably in all subgroups. According to the results of 24-hour BP monitoring, smokers from the carvedilol group did not demonstrate any marked BP dynamics, in contrast to their non-smoking peers. Smokers treated with nebivolol demonstrated no reduction in mean 24-hour levels of systolic BP (SBP), with some reduction in mean 24-hour and mean daytime levels of diastolic BP (DBP), as well as a decrease in SBP and DBP variability. Amlodipine effectively reduced mean 24-hour BP levels in both smokers (by 10,0/8,0 mm Hg) and non-smokers (by 11,3/6,5 mm Hg), with similar dynamics of mean daytime SBP and DBP and mean nighttime SBP. Lung function parameters in smokers receiving amlodipine did not change, while the β-adrenoblocker treatment negatively affected these parameters in smokers. In the carvedilol group, smokers demonstrated a significant reduction in FEV1; in the nebivolol group, FEV1, FLC, and their ratio significantly decreased in smokers.Conclusion. In young and middle-aged smokers with AH, antihypertensive effects, as assessed with the 24-hour BP monitoring, were weaker for carvedilol (SBP and DBP) and nebivolol (DBP). Amlodipine was highly effective in both smokers and non-smokers. Therefore, amlodipine could be recommended as one of the first-choice medications for smoking patients with AH.
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Fedorishina et al. (2013) conducted an RCT in arterial hypertension (n=130). carvedilol, nebivolol, and amlodipine vs. active comparators was evaluated on dynamics of office blood pressure, 24-hour BP monitoring, and lung function.
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