Use of nebivolol in patients with idiopathic pulmonary hypertension: Results of the pilot study


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AIM: Тo study the impact of 24-week therapy with nebivolol in a dose of 5 mg/day on the clinical and functional status of patients with idiopathic pulmonary hypertension (IPH), echocardiographic parameters, and blood levels of vasoactive mediators and nitric oxide (NO) metabolite. /MATERIAL AND METHODS: During continuous standard therapy comprising dihydropyridine calcium antagonists, warfarin, and diuretics, 12 patients with IPH and functional class (FC) II-III received nebivolol in a dose of 5 mg/day for 24 weeks. According to the data of right heart catheterization, all the patients had a positive acute pharmacological test with a vasodilator (NO). Six-minute walk test (6'WT), estimation of the Borg dyspnea index (BDI) and FC, transthoracic echocardiography (EchoCG), and measurements of the levels of NO metabolites, endothelin-1, (ET-1), thromboxane B2 (TxB2), and 6-keto-prostaglandin F1α (6-ketoPG F1α) were done at baseline and after 12 and 24 weeks of the therapy /RESULTS: Following 24-week nebivolol treatment, there was a statistically significant increase in 6'WT distance (from 473±47.6 to 516.7±58.4 m; р<0.0001) and a drop in BDI (from 3.4±2.2 to 1.1±0.7; р<0.05) and FC (from 2.9±0.4 to 1.7±0.2; р<0.05). Doppler EchoCG showed that pulmonary artery systolic pressure statistically significantly decreased (91.6±30 to 78.3±39 mm Hg; р=0.05) at 12 weeks and slightly increased up to 83.2±32.4 mm Hg at 24 weeks. After 24-week treatment, the anteroposterior dimensions of the right ventricle (RV) statistically significantly reduced (from 4.4±0.6 to 3.8±1.2 cm; р<0.05). The other EchoCG parameters remained substantially unchanged. There was a statistically reduction in the level of ET-1 (from 2.99±1.1 to 2.17±0.8 µmol/l; р<0.05). The concentrations of 6-ketoPG F1α, TxB2, and NO metabolite remained substantially unchanged at 24 weeks of treatment with nebivolol. There were no adverse reactions requiring that the dose of the drug be discontinued or reduced. Heart rate tended to be lower at a 24-week follow-up. All the patients continued taking nebivolol after completion of the study /CONCLUSION: Therapy with nebivolol in a dose of 5 mg/day for 24 weeks led to a significant functional improvement in the patients with IPH and reductions in RV dimensions and blood ET-1 levels. The therapy did not cause adverse reactions.

About the authors

T V Martyniuk

ФГБУ РКНПК "Институт клинической кардиологии им. А.Л. Мясникова"

Email: trukhiniv@mail.ru

I D Konosova

ФГБУ РКНПК "Институт клинической кардиологии им. А.Л. Мясникова"

I E Chazova

ФГБУ РКНПК "Институт клинической кардиологии им. А.Л. Мясникова"

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