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β-Blockade With Nebivolol for Prevention of Acute Ischemic Events in Elderly Patients With Heart Failure
Study Questions:
Does nebivolol, a beta-blocker with B-1 selectivity and nitric oxide modulating properties, reduce ischemic events in elderly patients with heart failure (HF)?
Methods:
This was a substudy of elderly patients (ages ≥70 years) with ischemic HF (left ventricular ejection fraction [LVEF] ≤35% or hospitalization within 12 months for HF), who were enrolled into the SENIORS trial. Such patients (n = 1,452) underwent blinded randomization to nebivolol versus placebo added onto standard HF therapy. The primary outcome was hospitalization/death from acute myocardial infarction or unstable angina and sudden death.
Results:
Patients in the nebivolol group (n = 735) were similar at baseline to the placebo group (n = 717), except for fewer males were on nebivolol. Angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers were used in 90% of patients, and 60% had an LVEF ≤35% and 95% were New York Heart Association class II or III. Sixteen percent of patients in the placebo group compared with 11% of patients treated with nebivolol reached the primary endpoint (adjusted HR, 0.68; 95% confidence interval [CI], 0.51-0.90). Nebivolol therapy also reduced the risk of sudden death (HR, 0.62; 95% CI, 0.41-0.92), with strong nonsignificant trends in reducing all-cause mortality and cardiovascular hospitalizations (HR, 0.84; 95% CI, 0.7-1.0).
Conclusions:
The authors concluded that nebivolol reduced ischemic events in elderly patients with HF.
Perspective:
Activation of neurohormones and the sympathetic nervous system is known to promote the development and progression of HF in patients with and without coronary disease. In this elderly group of patients with ischemic HF (systolic or diastolic), therapy with nebivolol reduced hospitalization and death from ischemic events. Prior coronary interventions in this group were low (~5% had percutaneous and ~11% had bypass interventions), but the burden of hypertension (66% with mean systolic blood pressures of 141 mm Hg) was high. It would have been interesting to know if blood pressures were lower in the nebivolol group, given the drug’s additional vasoactive properties. An active control arm with another beta-blocker (such as toprol or carvedilol) may also help elucidate if the results are related to nebivolol or beta-blockers in general.
Keywords: Myocardial Infarction, Coronary Disease, Blood Pressure, Propanolamines, New York, Benzopyrans, Vasodilator Agents, Nitric Oxide, Carbazoles, Heart Failure, Hypertension, Ethanolamines
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