Effects of Nebivolol and Telmisartan on Blood Pressure, Diastolic Functions, Lipid and Glucose Metabolism in Hypertensive Cases

Abstract

Objectives: Nebivolol and Telmisartan has been claimed to ensure effective control of the blood pressure and target organ. The aim of our study was to investigate the effects of nebivolol and telmisartan on glucose-lipid metabolism, as well as diastolic dysfunction and left ventricle hypertrophy, which are held responsible for target organ damage. Materials and Methods: The study enrolled 100 patients whose mean age was 50.1 ± 9.9 and who had essential hypertension (50 patients were administered 5 mg/day Nebivolol and 50 patients were administered 80 mg/day Telmisartan for six months). Results: Mean blood pressure fell from 108.1±9.6 mmHg to 88.8±6.8 mmHg in the nebivolol group (p=0.001) and from 108.8±2.2 mmHg to 95.3±3.5 mmHg in the telmisartan group (p=0.001). Insulin resistance changed from 3.27±2.15 to 3.72±2.02 in the nebivolol group (p=0.13) and from 2.56±1.3 to 2.72±1.52 in the telmisartan group (p>0.05). Echocardiography showed a decrease in the left ventricle mass indices (p

Keywords

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Hipertansif Olgularda Nebivolol ve Telmisartan'ın Kan Basıncı, Diyastolik Fonksiyonlar, Lipid ve Glukoz Metabolizması Üzerine Etkileri

Öz

Amaç: Nebivolol ve Telmisartan etkin kan basıncı kontrolü sağlar ve hedef organ hasarı üzerine olumlu etkileri vardır. Çalışmamızın amacı nebivolol ve telmisartanın glükoz-lipid metabolizması üzerine ve hedef organ hasarından sorumlu tutulan diyastolik disfonksiyon ve sol ventrikül hipertrofisi (SVH) üzerine olan etkilerini irdelemek idi. Gereç ve Yöntem: Çalışmaya yaş ortalaması 50.1±9.9 olan esansiyel hipertansiyonlu 100 hasta alındı. Elli hastaya Nebivolol 5 mg/gün, diğer 50 hastaya ise Telmisratan 80mg/gün altı ay süre ile verildi. Bulgular: Ortalama kan basıncı nebivolol grubunda 108.1±9.6 mmHg'dan 88.8±6.8 mmHg'a (p=0.001), telmisartan grubunda ise, 108.8±2.2 mmHg'dan 95.3±3.5 mmHg'a geriledi (p=0.001). İnsülin direncinde nebivolol grubunda 3.27±2.15'den 3.72±2.02'ye (p=0.13) telmisartan grubunda ise 2.56±1.3'den 2.72±1.52'ye değişim tespit ettik (p>0.05). Ekokardiyografik olarak her iki grupta da sol ventrikül kitle indekslerinde azalma (p

Anahtar Kelimeler

• Nebivolol, Telmisartan, Hipertansiyon

References

1. Report of the Joint National Commite on prevention, detection, eveluation and treatment of High Blood Pressure (JNC-VI) Guidelines for the management of hypertension. Arch Intern Med 1997; 157: 2413-2466.
2. Andrew MD, Lip GYH, Blann D. Relation Endothelium, thrombogenesis, and haemorheology in systemic hypertension to ethnicity and left ventricular hypertrophy. Am J Cordiol 1997; 80: 1566-1571.
3. Leysen JE, Pauwels PJ, Gommeren W, Lommen G, Janssen PAJ. The receptor binding profile of the new antihypertensive agent nebivolol and its steroisomers compared with various betaadrenergic blockers. Dur Invest 1991; 3(suppl 1): 120-121. 4. Janssens WJ, Xhonneux R, Janssen PAJ. Animal pharmacology of Nebivolol. Drug Investşgation 3 (Suppl. 1): 1991; 13-24.
4. Janssens WJ, Van de Water A, Xhonneux R, Reneman RS, Van Nueten JM, Janssen PA. Nebivolol is devoid of intrinsic sympathomimetic activity. Eur J Pharmacol 1989 Jan 2; 159: 89-95.
5. The sixt report of Jiont İnternational Committe on Prevention, Detection, Evaluation and treatment of high blood pressure; NIH Publication, November 1997.
6. Kurtz TW, Pravenec M. Antidiabetic mechanisms of angiotensinconverting enzyme inhibitors and angiotensin II receptor antagonists: beyond the renin-angiotensin system. J Hypertens 2004; 22: 2253-2261.
7. Haffner SM, Miettinen H, Stern MP. The homeostasis model in the San Antonio Heart Study.Diabetes Care 1997 Jul; 20: 10871092.
8. Castellanos A, Kessler KM, Myerburg RJ. The resting electrocardiogram. In Alexander RW, Schlant RC, Fuster V. Hurst's The Heart, volume 1, USA, The McGraw-Hill Companies, 9 th edition, 1998; pp.371.

9. Devereux RB. Method of recognition and assessment of left ventricular hypertrophy. Medicographia 1995; 17: 12.
10. Devereux RB, De simone G, Schlussel CY. Echocardiographic left ventricular mass predicts risk of developing subseguent borderline hypertension. Am Coll Cardiol 1990; 15: 210-18.
11. Garcia MJ, Thomas JD, Klein AL. New doppler echocardiographic applications for the study of diastolic dysfunction. J Am Coll Cardiol 1998; 32: 865-875.
12. Andrew MD, Lip GYH, Blann D. Relation Endothelium, thrombogenesis, and haemorheology in systemic hypertension to ethnicity and left ventricular hypertrophy. Am J Cordiol 1997; 80: 1566-1571.
13. Gifford RWJ, Kirkendall W, O’Connor DT, Weidman W. Office evaluation of hypertension. A statement for health professionals by a writing group of the Council for High Blood Pressure Research, American Heart Association. Circulation 1989; 79: 721-731.
14. Pessina AC. Metabolic effects and safety profile of nebivolol. J Cardiovasc Pharmacol 2001; 38 (Suppl 3): 33-35.
15. Cockcroft JR, Chowienczyk PJ, Brett SE, Chen CP, Dupont AG, Van Nueten L, et all. Nebivolol vasodilates human forearm vasculature: evidence for an L-arginine/NO-dependent mechanism. J Pharmacol Exp Ther 1995; 274: 1067-1071.
16. Rosei EA, Rizzoni D, Comini S, Boari G; Nebivolol-Lisinopril Study Group. Evaluation of the efficacy and tolerability of nebivolol versus lisinopril in the treatment of essential arterial hypertension: a randomized, multicentre, double-blind study. Blood Press 2003; 1(Suppl): 30-35.
17. Van Nueten L, Rishoj Nielsen M, Vertommen C, Dupont AG, Robertson JI Nebivolol versus enalapril in essential hypertension: a long-term double-blind comparative trial. Acta Clin Belg 1999; 54: 19-25.
18. Korlipara K, Van Nuetten L, Cornwell L. Nebivolol versus nifedipin in the treatment of essential hypertension. Multicenter international nebivolol trial Clinical research report NEBINT5 Beerac Belgium: Janssen Research Foundation: 1994.
19. Van Bartel LMAB, Breed JGS, Joosten J, Kragten A, Lusterning FATh, Moolj JMV. Nebivolol in hypertension: a double bind placebo controlled multicenter study assessing its antihypertansiveefficacy and impact on quality of life. J Cardiovasc Pharmacol 1993; 2: 856-862.
20. Mazza A, Gil-Extremera B, Maldonato A, Toutouzas T, Pessina AC. Nebivolol vs amlodipine as first-line treatment of essential arterial hypertension in the elderly. Blood Press 2002; 11: 182188.
21. Lacourciere Y, Lefebvre J, Poirier L, Archambault F, Arnott W. Treatment of ambulatory hypertensives with nebivolol or hydrochlorothiazide alone and in combination. A randomized, double-blind, placebo-controlled, factorial-design trial. Am J Hypertens 1994; 7: 137-145.
22. Wienen W, Entzeroth M, Jakobus CA. Neva Press, Branford, Connecticut Cardiovascular Drug 2000; 18: 127-154.
23. Neutel JM, Smith DHG. Dose response and antihypertensive efficacy of the AT1 receptor antagonist Telmisartan in patients with mild to moderate hypertension. Adv Ther 1998; 15: 206217.
24. Nodari S, Metra M, Dei Cas L. Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs nebivolol. Eur J Heart Fail 2003; 5: 621-27.
25. Fountoulaki K, Dimopoulos V, Giannakoulis J, Zintzaras E, Triposkiadis F. Left ventricular mass and mechanics in mild-tomoderate hypertension: effect of nebivolol versus telmisartan.Am J Hypertens 2005; 18: 171-177.
26. Galzerano D, Tammaro P, del Viscovo L, Lama D, Galzerano A, Breglio R, Tuccillo B, Paolisso G, Capogrosso P Threedimensional echocardiographic and magnetic resonance assessment of the effect of telmisartan compared with carvedilol on left ventricular mass a multicenter, randomized, longitudinal study. Am J Hypertens 2005; 18: 1563-1569.
27. Mattioli AV, Zennaro M, Bonatti S, Bonetti L, Mattioli G. Regression of left ventricular hypertrophy and improvement of diastolic function in hypertensive patients treated with telmisartan. Int J Cardiol. 2004; 97: 383-88.
28. Tedesco MA, Ratti G, Aquino D, Limongelli G, di Salvo G, Mennella S, et al. Effects of losartan on hypertension and left ventricular mass : a long-term study. J Hum Hypertens 1998; 12: 505-510.
29. Martina B, Dieterle T, Weinbacher M, Battegay E. Effects of losartan titrated to losartan/hydrochlorothiazide and amlodipine on left ventricular mass in patients with mild tomoderate hypertension. A double-blind randomized contralled study. Cardiology 1999; 92: 110-114.
30. Almazov VA, Shlyakhto EV, Konrady AO, Macsimova TA, Zaharov DV, Rudomanov OG. Correction of hypertensive cardiac remodelling: comparison different antihypertensive therapies. Med Sci Monit 2000; 6: 309-313.
31. Panov AV, Conrady AO, Usatchev NI, Kruticov AN, Polunicheva EV. Long term treatment and cardiac structure in patients with essential hypertension. 4 th Int Symp on Anjiotensin II Antogonism, London, 3-5 Apr 2001.
32. Mattioli AV, Fontanesi L, Bonatti S. Effects of regression of left ventricular hypertrophy on diastolic function in hypertensive patients. Am J Hypertens 2002; 15: 44-49.
33. Ivanova OV, Sergakova LM, Chernova NA, Rogoza AN, Korpov YA. Telmisartan monotherapy in patients with mild-to-moderate essential hypertension: ambulatory blood pressure monitoring and echocardiographic evaluation. 11 th Eur Mtg on Hypertension, Milan, 15-19 Jun 2001 J Hypertens; 19(Suppl2) pp.270.
34. Malmqvist K, Kahan T, Edner M, Held C, Hagg A, Lind L, et al. Regression of left ventricular hypertrophy in human hypertension with irbesartan. J Hypertens 2001; 19: 1167-1176.
35. Burlew BS, Weber KT: Connective tissue and the heart. Functional significance and regulatory mechanisms. Cardiol Clin 2000; 18: 435–442.
36. Neutel J, Smith DH: Evaluation of angiotensin II receptor blockers for 24-hour blood pressure control: meta-analysis of a clinical database. J Clin Hypertens 2003; 5: 58–63.
37. Shimamoto K. Insulin resistance syndrome and hypertension. Hokkaida Igaku Zasshi 2000; 75: 9-14.
38. Olsen MH, Fossum E, Hjerkinn E, Wachtell K, Hoieggen A, Nesbitt SD, et al. Relative influence of insulin resistance versus blood pressure on vasculer changes in longstanding hypertension. ICARUS, a LIFE sub study. Insulin Carotids US Scandinavia. J Hypertens 2000; 18: 75-81.
39. Paternostro G, Pagano D, Gnecchi-Ruscone T, Bonser RS, Camici PG. Insulin resistance in patients with cardiac hypertrophy. Cardiovasc Res 1999; 42: 246-253.
40. Messerli FH, Aepfelbacher FC. Hypertension and left ventricular hypertrophy. Cardiol Clin 1995; 13: 549-557.
41. Leonetti G., Cuspidi C. Hypertension and coronary hearth dissease in. Kaplan NM ed. Metabolic aspects of hypertension. London Science Press 1994; 5: 1-5.
42. Fogari R, Zoppi A, Lazzari P, Mugellini A, Lusardi P, Preti P, at all. Comparative effects of nebivolol and atenolol on blood pressure and insulin sensitivity in hypertensive subjects with type II diabetes. J Hum Hypertens 1997 Nov; 11: 753-757.
43. Weidmann P, Uehlinger DE, Gerber A. Antihypertensive treatment and serum lipoproteins. J Hypertens.1985; 3: 297-306.
44. Chov L, De Gasparo M , Levens N. Improved glucose metobolism following blockade of angiotensin converting enzyme but not angiotensin AT1 receptors. Eur J Pharmacol 1995; 282: 77-86.
45. Higashiura K, Ura N, Miyazaki Y, Shimamoto K. Effect of an angiotensin II receptor antogonist, candesartan, on insulin resistance and pressor mechanisms in essential hypertension. J Hum Hypertens 1999; 13 Suppl 1: 71-74.
46. Ura N, Higashiura K, Shimamoto K. The mechanisms of insulin sensitivity improving effects of angiotensin converting enzyme inhibitor. Immunopharmacology 1999; 44: 153-159.
47. Caldiz CI, de Cingolani GE. Insulin resistance in adipocytes from spontaneously hypertensive rats: effect of long term treatment with enapril and losartan. Metobolism 1999; 48: 1041-1046.
48. Derosa G, Ragonesi PD, Mugellini A, Ciccarelli L, Fogari R. Effects of telmisartan compared with eprosartan on blood pressure control, glucose metabolism and lipid profile in hypertensive, type 2 diabetic patients: a randomized, doubleblind, placebo-controlled 12-month study. Hypertens Res. 2004; 27: 457-464.
49. Miura Y, Yamamoto N, Tsunekawa S, Taguchi S, Eguchi Y, Ozaki N, Oiso Y Replacement of valsartan and candesartan by telmisartan in hypertensive patients with type 2 diabetes: metabolic and antiatherogenic consequences. Diabetes Care 2005; 28: 757-758.