Comparative effects of a two-week treatment with nebivolol and nifedipine in hypertensive patients suffering from COPD

Background: It has been suggested that the antihypertensive agent nebivolol, a beta(1)-adrenoceptor-blocking agent that modulates the endogenous production of nitric oxide, is preferable to 'conventional' beta(1)-blockers in hypertensive patients with airway dysfunction. Objectives: Since beta(1)-blockade by nebivolol is larger after repeated dosing than after a single oral intake, we have explored its effect on pulmonary function after a 2-week treatment in hypertensive patients with mild to moderate COPD. Methods: A single-blind crossover design was used. Twenty patients with COPD as selected above and with a diastolic blood pressure of 95 - 110 mm Hg after 1 week of placebo run-in were entered into the two 2-week active treatment periods with either 5 mg nebivolol ( n = 10) or 30 mg nifedipine gastrointestinal-transport-system (GITS) ( n = 10) taken for a period of 2 weeks. After a further 1-week washout, subjects were crossed-over to receive the other drug for 2 additional weeks. At each visit, changes in spirometric indexes and the interaction with the bronchodilator effect of salbutamol were investigated. Moreover, systolic and diastolic blood pressure ( BP) together with heart rate were manually measured in order to evaluate the cardiovascular effects of the different treatments. Throughout the study, patients recorded symptoms. Results: Similar and significant reductions in systolic and diastolic BP were observed with both treatments. The impact of nifedipine on FEV1 was not significant (p > 0.05), while that of nebivolol was slight. The maximum response to salbutamol was slightly decreased with either nebivolol or nifedipine GITS. Day-today airway obstruction control, interpreted from patient recordings of symptom scores and inhaler use, was similar with both treatments. Conclusions: Our pilot study suggests that the use of nebivolol in hypertensive patients with stable mild to moderate COPD was safe during a 2-week trial. Evaluation of longer time periods, larger patient numbers with more severe COPD or during exacerbations is warranted. Copyright (C) 2004 S. Karger AG, Basel.