Blood pressure effects of combined β-blocker and angiotensin-converting enzyme inhibitor therapy compared with the individual agents: a placebo-controlled study with nebivolol and lisinopril

The Journal of Clinical Hypertension, 06/08/2012

This study demonstrated the potential antihypertensive benefits of combining nebivolol with a renin–angiotensin system (RAS) blocker.

Methods

  • The authors tested the additivity of the β–blocker nebivolol, which has vasodilating activity, with the angiotensin–converting enzyme inhibitor lisinopril in patients with stage 2 diastolic hypertension.
  • The BP effects of placebo (n=93), nebivolol 5 mg to 20 mg daily (n=185), lisinopril 10 mg to 40 mg daily (n=189), and nebivolol 5 mg to 20 mg + lisinopril 10 mg to 40 mg (n=189) during 6 weeks of treatment were compared.
  • The primary end point was change in diastolic BP (DBP).
  • For the full cohort, baseline BP was 163.8/104.4 mm Hg, mean age was 49.2 years, 58% were men, 62% were white, and 34% were black.

Results

  • DBP fell by 17.2±10.2 mm Hg with the combination, greater than placebo (8.0±9.2, P<.0001), nebivolol (13.3±8.9, P=.0010), and lisinopril (12.0±9.8, P<.0001).
  • For systolic BP, corresponding reductions were 19.2±19.8 mm Hg, 9.9±16.4 (P<.0001 vs combination), 14.4±14.1 (P=.0470), and 16.1±17.2 (P=.0704).
  • Adverse event rates were similar in all groups.

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