Author(s): Anand Dev1, Sanjeet Kumar Pandit2, Vinod Kumar Singh3, Soubhagya Mishra4, Vishvanayak5, Brajendra Kumar6, Bhumesh Tyagi7, Shruti Sanjay Gandhi8
Beta-blocker is considered to be a very effective antihypertensive drug to control hypertension. But National Institute for Health and Clinical Excellence (NICE) recommended that it should no longer be used as first-line drug as the treatment of uncomplicated hypertension. This recommendation was based on the various studies showing increased risk of new onset Diabetes Mellitus and derangement of lipid metabolism with the use of beta-blocker. These studies were mainly based on Atenolol with or without diuretics. We are in need of a beta-blocker that has effective antihypertensive properties without altering the metabolic profile like blood sugar level and lipid metabolism. Nebivolol, a b1-selective blocker, has got more or less the similar properties. It increases insulin sensitivity in patients with insulin resistance due to its vasodilator properties. Also, antioxidant properties of nebivolol, and increase in nitric oxide properties by reducing its oxidative inactivation may be responsible for beneficial lipid and carbohydrate metabolic profile.
MATERIALS AND METHOD
A prospective study was conducted between December 2011 to August 2013 on 60 patients at medicine outpatient department (OPD) of Katihar Medical College, Katihar, after getting approval from the Institutional Ethics Committee. The patients meeting the inclusion criteria were explained in detail about the nature of the trial, its purpose, procedures, and followup. They were provided with detailed trial information sheet. Written informed consent was obtained from those who volunteered to participate in the trial.
In our study, the mean difference of systolic blood pressure from baseline and at 24 weeks was 40.20±1.74 in the Atenolol group and 43.80±1.405 in the Nebivolol group. Similarly, in Atenolol group, diastolic blood pressure is decreased by 17±1.3 and 19.4±1.223 in Nebivolol group.
In our study, the mean difference of blood sugar level from baseline and at 24 weeks was 18.43 ±1.216 in the Atenolol group and 1.08±1.134 in the Nebivolol group.
In this study, the mean difference of Total cholesterol, Triglycerides, VLDL, HDL, and LDL from baseline and at 24 weeks is 20.83±1.034, 15.96±1.784, 3.20±0.297, -2.97±0.203, and 21.46±1.04 respectively in the Atenolol group and 0.63±0.758, 0.17±0.667, 0.00±0.200, 0.12±0.302, and 0.44±0.684, in the Nebivolol group.
Our study clearly shows that Nebivolol is highly effective antihypertensive therapy as Atenolol and very minimal or no derangement observed in forms of blood sugar, TG, VLDL, HDL, and LDL level after successful therapy with Nebivolol. Hence Nebivolol, a selective beta-blocker with vasodilator properties should be considered to be a first line antihypertensive therapy.