Nebivolol and metoprolol: long-term effects on inflammation and oxidative stress in essential hypertension

Abstract

Arterial hypertension is characterised by increased oxidative stress and inflammation, which are associated with further cardiovascular risk. The aim of our study was to investigate the long-term effects of nebivolol and metoprolol succinate on oxidative stress, and on inflammatory and pro-inflammatory markers in patients with hypertension. Eighty patients with never-treated mild-to-moderate essential hypertension, aged 30–65 years, were randomised to a 5 mg daily dose of nebivolol or a 50–100 mg daily dose of metoprolol succinate. Brachial blood pressure, plasma oxidized LDL (oxLDL), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), fibrinogen, intercellular adhesion molecule-1 (ICAM-1), asymmetric dimethylarginine (ADMA), and urine 8-isoprostane levels were measured before and after 1 year of treatment. Nebivolol and metoprolol reduced equally significantly brachial blood pressure. The oxLDL was significantly reduced in both groups (p < 0.01 and for both drugs), but only nebivolol reduced 8-isoprostanes (p = 0.01). In the metoprolol group, change in oxLDL levels correlated with change in systolic blood pressure (r = 0.45; p < 0.01) and pulse pressure (r = 0.47; p < 0.01). Both metoprolol and nebivolol reduced ICAM-1 (p < 0.01). There was no change in IL-6, hsCRP, fibrinogen, or ADMA levels in either group. These data suggest that in long-term antihypertensive treatment both the cardioselective beta blocker metoprolol succinate and the vasodilating beta blocker nebivolol have inflammation-related effects but only nebivolol has a favourable blood pressure-independent effect on oxidative stress.

Key Words::

• Adrenergic beta-antagonists
• isoprostanes
• oxidized low density lipoprotein
• cell adhesion molecules

Acknowledgements

The authors would like to thank all patients who participated in the study. We are grateful to the study physicians Drs Kristina Lotamõis and Ingmar Lindström, the study nurse Eva-Brit Mölder and the technician Annelii Sikk for their invaluable assistance. We thank Ester Jaigma for the linguistic revision of the manuscript and Mart Kals for his assistance with the statistical analysis.

Funding Sources: This study was supported by the Berlin-Chemie Menarini, Estonian Science Foundation grants Nos. 7480, 8273, and 9094 and by target financing Nos. 0180105s08 and SF0180001s07.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.