奈比洛尔可降低一氧化氮敏感性高血压

关键信息

该项双盲交叉研究纳入20例自主神经衰竭合并卧位高血压的患者，每日夜间给予单剂量奈比洛尔、美托洛尔（阴性对照）和西地那非（阳性对照），夜间每2小时测量卧位血压。与安慰剂组相比，西地那非组（P < 0.001）和奈比洛尔组（P= 0.036）均使收缩压降低，而美托洛尔没有影响。对西地那非有反应的患者（血压降低大于20mmHg），奈比洛尔可显著降低其收缩压；但对西地那非无反应的患者，奈比洛尔未能显著降低血压。

氧化一氮增强效应可促进奈比洛尔的抗高血压作用，与该假说相同，奈比洛尔也可降低自主神经衰竭患者的卧位高血压，独立于β1-阻滞剂。

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This double-blind crossover study randomized 20 autonomic failure patients with supine hypertension to receive a single oral dose of nebivolol, metoprolol (negative control), and sildenafil (positive control) on separate nights. Every 2 hours throughout the night supine blood pressure was measured. Both sildenafil and nebivolol decreased systolic blood pressure compared with placebo (P < .001 and P= .036, respectively), but metoprolol had no effect. Among patients who responded to sildenafil (blood pressure fall >20 mmHg), nebivolol significantly lowered systolic blood pressure but did not significantly lower blood pressure in sildenafil nonresponders.

Consistent with the hypothesis that nitric oxide potentiation contributes to the antihypertensive effect of nebivolol, nebivolol lowered supine hypertension in autonomic failure, independent of β1-blockade.

Hypertension

Nebivolol, But Not Metoprolol, Lowers Blood Pressure in Nitric Oxide-Sensitive Human Hypertension

Hypertension 2014 Sep 29;[EPub Ahead of Print], LE Okamoto, A Gamboa, CA Shibao, AC Arnold, L Choi, BK Black, SR Raj, D Robertson, I Biaggioni

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