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Hypertrophic Cardiomyopathy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Ahmad Masri, Stephen B. Heitner
In general, long-acting formulations are preferred in the treatment of LVOT obstruction, with propranolol and metoprolol being the best-studied β-blockers. Despite limited evidence, agents with alpha-blocking activity (carvedilol, labetalol, bisoprolol) are thought to aggravate LVOT obstruction and, in general, are avoided in obstructive HCM, with the exception being patients with coexistent systemic hypertension. We have had success with careful institution of carvedilol when concomitant control of both obstructive HCM symptoms and hypertension was warranted. Nebivolol is a unique β-blocker which also produces an endothelium-derived nitric oxide-dependent vasodilation, resulting in reduction of blood pressure, and theoretically should be avoided in patients with obstructive HCM.
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Nebivolol is a beta-blocker. It has not been studied during human pregnancy. In rats and rabbits given up to 10 times the usual human dose during organogenesis, the frequency of birth defects was not increased. Fetal weight and bone ossification were delayed at birth, but was reversible postnatally. Only one infant exposed to nebivolol in the Swedish Birth Defects Registry (Kallen, 2019).
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei, Michel Azizi, Michel Burnier, Denis L. Clement, Antonio Coca, Giovanni de Simone, Anna F. Dominiczak, Thomas Kahan, Felix Mahfoud, Josep Redon, Luis M. Ruilope, Alberto Zanchetti, Mary Kerins, Sverre E. Kjeldsen, Reinhold Kreutz, Stéphane Laurent, Gregory Y.H. Lip, Richard McManus, Krzysztof Narkiewicz, Frank Ruschitzka, Roland E. Schmieder, Evgeny Shlyakhto, Konstantinos P. Tsioufis, Victor Aboyans, Ileana Desormais
Finally, beta-blockers are not a homogeneous class. In recent years, the use of vasodilating beta-blockers – such as labetalol, nebivolol, celiprolol, and carvedilol – has increased. Studies on nebivolol have shown that it has more favourable effects on central BP, aortic stiffness, endothelial dysfunction, and so on. It has no adverse effect on the risk of new-onset diabetes and a more favourable side effect profile than classical beta-blockers [307,308], including less adverse effects on sexual function. Bisoprolol, carvedilol and nebivolol have been shown to improve outcomes in RCTs in heart failure [136]; however, there are no RCTs reporting patient outcomes with these beta-blockers in hypertensive patients.
Paradoxical Raynaud’s phenomenon following iloprost infusion in a patient with systemic sclerosis
Published in Scandinavian Journal of Rheumatology, 2023
D Bertelle, E Bertoldo, R Bixio, M Rossini
In August 2021, after approximately 10 years of monthly stable vasodilating therapy with iloprost, the patient presented an abrupt worsening of RP with a persistent cyanotic phase during the iloprost infusion. The intensity of the attack was 10/10 on the visual analogue scale for Raynaud’s phenomenon (VAS-RP). Vascular symptoms began a few minutes after the start of infusion and receded rapidly with discontinuation. The only recent change in pharmacological treatment was the introduction of nebivolol in September 2020 as an anti-hypertensive drug; however, no worsening in his vascular symptoms was experienced at the time. Furthermore, nebivolol is one of the beta-blockers recommended in RP owing to its pharmacodynamic properties (2). In the following infusions (4 weeks apart), we progressively reduced the iloprost rate, observing an improvement of the RP during the infusions. The referred VAS-RP was reduced to 5/10 and 2/10 at 1.3 ng/kg/min and 1.15 ng/kg/min infusion rates, respectively (Figure 1). Between the infusions, the patient reported only a few (average two per week), mild (VAS-RP < 3) RP episodes.
Extemporaneous combination therapy with nebivolol/zofenopril in hypertensive patients: usage in Italy
Published in Current Medical Research and Opinion, 2022
Massimo Volpe, Valeria Pegoraro, Ilaria Peduto, Franca Heiman, Suada Meto
Nebivolol is a third generation long-acting and highly selective β1-adrenergic receptor antagonist, which is approved for the treatment of hypertension in the United States, as well as for the treatment of hypertension and chronic heart failure in Europe. Several studies on nebivolol have shown significant reduction of BP, heart rate and peripheral resistance, and increase of stroke volume with the preservation of cardiac output as well as improvement of coronary flow reserve. Nebivolol has shown favorable effects on central BP, aortic stiffness and endothelial dysfunction24. Furthermore, nebivolol exerts neutral or even favorable effects on both carbohydrate and lipid metabolism25 and has a more favorable safety profile than the classical BBs, including reduced adverse effects on sexual function26, and good tolerability in chronic obstructive pulmonary disease patients27. Zofenopril is a drug belonging to the angiotensin-converting enzyme (ACE) class which, since its discovery, has been widely used in the treatment of CV and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes and hypertension28. Comparative data from several clinical trials have shown that zofenopril is an effective and well tolerated drug for the treatment of hypertension, as well as for acute myocardial infarction29.
Benefit–risk review of different drug classes used in chronic heart failure
Published in Expert Opinion on Drug Safety, 2019
Gabriela Andries, Srikanth Yandrapalli, Wilbert S. Aronow
The efficacy of nebivolol in elderly patients (≥ 70 years) with HF was studied in a double-blind, multicenter RCT, the SENIORS Study (Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure) [71]. A total of 2,134 patients were enrolled and randomized to receive either nebivolol or placebo. Of note, this trial also included elderly population with HFmrEF and HFpEF (35% of patients). The investigators found 14% significant reduction in primary outcome composite of death or CV hospitalization in the nebivolol group, however there was no statistically significant difference in mortality alone [71].