ABSTRACT
This aim of this study was to evaluate the presence of endothelial dysfunction in patients with primary hypertension and to determine the usefulness of nebivolol, a selective beta-adrenoceptor blocking agent, as a potential treatment for endothelial dysfunction. Of 176 patients with stage I hypertension, 36 patients (20%), the majority of whom were overweight/obese, were found to have abnormal results with myocardial perfusion single-photon emission computed tomography (MP-SPECT) under cold pressor test conditions. These 36 patients were treated for 28 days with 5 mg/d nebivolol, after which only 3 (8.3%) still had abnormal MP-SPECT results. The mean ischemia score was consistent with moderate risk and decreased significantly after treatment with nebivolol. All hemodynamic variables measured (systolic and diastolic blood pressure and heart rate) were also reduced significantly by treatment with nebivolol. Endothelial dysfunction plays a key role in the pathogenesis of atherosclerosis and its reversal has considerable implications for clinical outcomes in affected patients. The cold pressor testing results of this study suggest that nebivolol may have beneficial anti-ischemic effects in the coronary arteries of patients with hypertension. However, these findings need to be confirmed in larger randomized controlled trials, ideally comparing nebivolol with other blood pressure lowering agents or NO synthase inhibitors.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Antihypertensive Agents/therapeutic use , Benzopyrans/therapeutic use , Endothelium, Vascular/drug effects , Ethanolamines/therapeutic use , Hypertension/drug therapy , Adrenergic beta-Antagonists/administration & dosage , Adult , Aged , Benzopyrans/administration & dosage , Endothelium, Vascular/diagnostic imaging , Endothelium, Vascular/physiopathology , Ethanolamines/administration & dosage , Female , Hemodynamics/drug effects , Humans , Hypertension/diagnostic imaging , Hypertension/physiopathology , Male , Middle Aged , Nebivolol , Registries , Tomography, Emission-Computed, Single-PhotonABSTRACT
PURPOSE: Based on our preclinic studies with autologous unfractionated bone marrow (AUBM) via coronary sinus with transitory occlusion, a clinic study in patients with chronic refractory angina was designed. The objectives were to evaluate tolerance of the procedure, safety, and feasibility with 1 year follow-up. METHODS AND MATERIALS: Clinical study with inclusion and exclusion criteria defined by an Independent Clinical Committee was carried out. Fifteen patients underwent transcoronary sinus administration with a 15-min occlusion of freshly aspirated and filtered AUBM (60-120 ml). Feasibility was evaluated with Seattle Angina Questionnaire (SAQ), Canadian Cardiovascular Society (CCS) angina classification, perfusion dipyridamole, and coronary angiography. RESULTS: There were no changes in the tolerance parameters. There were no deaths or myocardial infarction during the follow-up. Three patients were readmitted into the hospital. During the follow-up, one patient was diagnosed with cancer of the lung. Improvement of 30% in the quality of life was evaluated by SAQ. The CCS angina classification showed that the mean angina class was 3.0+/-0.53 at baseline, which improved to 1.6+/-0.63 at 1 year (P<.001). Perfusion imaging (core lab) showed improvement in 12 of 15 patients, with a mean improvement of 40.9% at rest (22 vs. 13) (P<.01) and 45.3% at stress (26.5 vs. 14.5) (P<.05). Coronary angiography showed more collateral vessels in 10 of 15 patients. CONCLUSIONS: We can conclude that AUBM via coronary sinus is feasible in patients with chronic refractory angina after 1 year follow-up, and it appears to be safe.
