Nebivolol Versus Metoprolol: Comparative Effects on Fatigue and Quality of Life
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 21 - 80 |
| Updated: | 10/21/2018 |
| Start Date: | October 2009 |
| End Date: | January 2011 |
Nebivolol Vs. Metoprolol: Comparative Effects on Fatigue and Quality of Life
Beta-blockers are prescribed to millions of people for treatment of hypertension. Fatigue is
a recognized and common side effect of beta-blockers that can have significant effects on
quality of life. Worse, many people taking a beta-blocker for years are not even aware of the
reduction of energy with which they are living.
A new vasodilating beta-blocker, nebivolol, which is approved by the FDA for treatment of
hypertension, appears to be far less associated with fatigue than are most currently
available beta-blockers. The purpose of this study is to compare nebivolol with the current
best-selling beta-blocker, metoprolol, and determine whether there is a significant
difference in side effects including fatigue, reduced exertion tolerance, and reduced quality
of life.
In this study, 30 subjects will take each of the 2 study drugs for 8 weeks, consisting of 4
weeks at a lower dose, and 4 weeks at a higher dose. All dosages are FDA-approved for
treatment of hypertension. Subjects and investigators will not know which drug is being
administered until completion of the study. Subjects will undergo a treadmill stress test and
will complete fatigue and quality of life questionnaires after each 4 weeks of treatment. An
echocardiogram and non-invasive measurement of aortic blood pressure will be performed after
8 weeks on each drug. Also, blood will be drawn and stored for possible measurement of drug
levels, after 4 and 8 weeks on each drug. Results on each drug will then be compared. If
nebivolol is found to cause significantly less fatigue, it would be of substantial importance
to the many millions of people who are on life-long beta-blocker therapy, and are living with
reduced energy.
a recognized and common side effect of beta-blockers that can have significant effects on
quality of life. Worse, many people taking a beta-blocker for years are not even aware of the
reduction of energy with which they are living.
A new vasodilating beta-blocker, nebivolol, which is approved by the FDA for treatment of
hypertension, appears to be far less associated with fatigue than are most currently
available beta-blockers. The purpose of this study is to compare nebivolol with the current
best-selling beta-blocker, metoprolol, and determine whether there is a significant
difference in side effects including fatigue, reduced exertion tolerance, and reduced quality
of life.
In this study, 30 subjects will take each of the 2 study drugs for 8 weeks, consisting of 4
weeks at a lower dose, and 4 weeks at a higher dose. All dosages are FDA-approved for
treatment of hypertension. Subjects and investigators will not know which drug is being
administered until completion of the study. Subjects will undergo a treadmill stress test and
will complete fatigue and quality of life questionnaires after each 4 weeks of treatment. An
echocardiogram and non-invasive measurement of aortic blood pressure will be performed after
8 weeks on each drug. Also, blood will be drawn and stored for possible measurement of drug
levels, after 4 and 8 weeks on each drug. Results on each drug will then be compared. If
nebivolol is found to cause significantly less fatigue, it would be of substantial importance
to the many millions of people who are on life-long beta-blocker therapy, and are living with
reduced energy.
- Hypothesis: the beta-blocker nebivolol is associated with less fatigue than metoprolol,
the most widely-prescribed beta-blocker
- Methods: a double-blinded crossover trial comparing nebivolol with metoprolol.
Experimental procedures: Subjects will undergo electrocardiogram and routine blood
testing, unless such tests have been performed within 6 months and are available for
review. Subjects entered into the study will receive each of the two study drugs for 8
weeks. Metoprolol succinate will be given at a dose of 50 mg daily for 4 weeks, then 100
mg daily for 4 weeks. For nebivolol, dosage will be 5 mg daily for 4 weeks and 10mg
daily for 4 weeks. Identical-appearing pills will be given, and the drugs will be given
in randomized order without a placebo run-in period.
At the end of each 4-week treatment period on each drug, subjects will undergo a treadmill
stress test (using the standard Cornell protocol), complete Quality of Life and fatigue
questionnaires, and have blood drawn and frozen for later analysis for drug levels.
At the end of 8 weeks of treatment on each drug, subjects will undergo echocardiography and
applanation tonometry (non-invasive measurement of aortic blood pressure) to assess heart
function.
At the end of the study, the blinded subjects will be asked which of the two study drugs they
preferred, and the extent to which their energy differed between the two drugs.
-Rationale: Millions of hypertensive patients are on life-long beta-blocker therapy. In many,
it reduces cardiac output and increases peripheral resistance to blood flow (1). It is
well-established that beta-blockers cause fatigue in many patients and reduce exertion
tolerance. Every physician knows this, and tacitly accepts that many patients are living with
this unwelcome side effect.
A new beta-blocker, nebivolol, has the standard beta-blocking effects, but also produces
blood vessel relaxation (vasodilation), probably through increased secretion of the
vasodilator nitric oxide. Studies indicate that nebivolol, unlike most beta-blockers, does
not cause constriction of peripheral blood vessels, and is associated with improved heart
function (2). Studies suggest that it is also less likely to cause fatigue (3).
Personal experience is consistent with this, as I have observed marked improvement in energy
in patients in whom I have prescribed nebivolol in place of a different beta-blocker. The
possibility of placebo effect of course cannot be excluded. Nevertheless, the known
hemodynamic differences between nebivolol and other beta-blockers, and the positive clinical
experience, warrant formal study to determine whether nebivolol is kinder than other
beta-blockers in terms of the important side effect of fatigue.
the most widely-prescribed beta-blocker
- Methods: a double-blinded crossover trial comparing nebivolol with metoprolol.
Experimental procedures: Subjects will undergo electrocardiogram and routine blood
testing, unless such tests have been performed within 6 months and are available for
review. Subjects entered into the study will receive each of the two study drugs for 8
weeks. Metoprolol succinate will be given at a dose of 50 mg daily for 4 weeks, then 100
mg daily for 4 weeks. For nebivolol, dosage will be 5 mg daily for 4 weeks and 10mg
daily for 4 weeks. Identical-appearing pills will be given, and the drugs will be given
in randomized order without a placebo run-in period.
At the end of each 4-week treatment period on each drug, subjects will undergo a treadmill
stress test (using the standard Cornell protocol), complete Quality of Life and fatigue
questionnaires, and have blood drawn and frozen for later analysis for drug levels.
At the end of 8 weeks of treatment on each drug, subjects will undergo echocardiography and
applanation tonometry (non-invasive measurement of aortic blood pressure) to assess heart
function.
At the end of the study, the blinded subjects will be asked which of the two study drugs they
preferred, and the extent to which their energy differed between the two drugs.
-Rationale: Millions of hypertensive patients are on life-long beta-blocker therapy. In many,
it reduces cardiac output and increases peripheral resistance to blood flow (1). It is
well-established that beta-blockers cause fatigue in many patients and reduce exertion
tolerance. Every physician knows this, and tacitly accepts that many patients are living with
this unwelcome side effect.
A new beta-blocker, nebivolol, has the standard beta-blocking effects, but also produces
blood vessel relaxation (vasodilation), probably through increased secretion of the
vasodilator nitric oxide. Studies indicate that nebivolol, unlike most beta-blockers, does
not cause constriction of peripheral blood vessels, and is associated with improved heart
function (2). Studies suggest that it is also less likely to cause fatigue (3).
Personal experience is consistent with this, as I have observed marked improvement in energy
in patients in whom I have prescribed nebivolol in place of a different beta-blocker. The
possibility of placebo effect of course cannot be excluded. Nevertheless, the known
hemodynamic differences between nebivolol and other beta-blockers, and the positive clinical
experience, warrant formal study to determine whether nebivolol is kinder than other
beta-blockers in terms of the important side effect of fatigue.
Inclusion Criteria:
- Individuals who are taking, or are about to begin taking, a beta-blocker, and who have
the approved indication of hypertension
Exclusion Criteria:
- Orthopedic ailments that would interfere with performance of treadmill testing
- Stroke or heart attack within the previous 1 year
- Symptomatic coronary disease within the past year (angina, shortness of breath)
- Clinically significant pulmonary disease (e.g. emphysema or asthma).
- Poorly controlled hypertension (blood pressure above 160 systolic or 100 diastolic)
- Patients with contra-indications to taking a beta-blocker (asthma or bradyarrhythmia)
- History of tachyarrhythmia (abnormal rapid heart rate)
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