الفهرس 
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Abstract
Blood Pressure variability (BPV) is associated with much cardiovascular disease. The usefulness of out-of-office BP evaluation using ambulatory blood pressure monitoring (ABPM) or home monitoring was well established before. Central BP becomes a better predictor of cardiovascular outcome than peripheral pressure, particularly in individuals with prominent pulse pressure (PP) amplification. Reduction in central BP by some antihypertensive drugs provides protective properties against subclinical organ damage. Pulse wave velocity (PWV) is considered the gold standard index of aortic stiffness. Recently, the goals of antihypertensive treatment are the reduction of 24-hour mean of blood pressure and its variability and positively influence the PWV.
Aim of the study
To compare new cardio selective B-blocker with vasodilatory effect (nebivolol 5mg) to angiotensin receptor blocker (valsartan 160mg) when both combined with amlodipine 10mg , regarding the effect on peripheral blood pressure, blood pressure variability (BPV) and pulse wave velocity (PWV) using central and ambulatory blood pressure measurement.
Method
The study conducted in the hypertension clinic of Beni-Suef University Hospital between October 2018 and August 2021. One hundred and twenty eight hypertensive patients were assigned for amlodipine 10 mg/valsartan 160 mg combination therapy (A/V) or amlodipine 10 mg /nebivolol 5mg combination therapy (A/N) by simple 1:1 randomization. Twenty six patients excluded over follow up visits. Statistical analysis applied on final number of patients; one hundred and two patients, divided as: 52 patients in A/V arm and 50 patients in A/N group.
Results
Baseline Patients’ characteristics were comparable between both groups. After 10-12 wk of treatment, reduction in Office and Central BP showed no statistical significant difference between both groups but were statistically significant within each group.
Difference in PWV and AIx was not statistically significant between both groups; (P=0.379) (P=0.803). Difference in PWV was statistically significant within A/N group only; (P PWV3-PWV1= 0.000). AIx was statistically significant within A/V group; (PAIX 3-AIX 1=0.000) and AV group (PAIX 3-AIX 1=0.013).
Reduction in HR was statistically significant only within A/N group; (P HR3– HR1) = 0.017 and no difference was found between both A/V and A/N group; P=0.093.
Reduction in central PP was statistically significant within A/N group only (P pp3-pp1= 0.002) with no difference between both groups.
Reduction in all day 24- hour AMBP readings was statistically significant within A/V group; (Psys 3 – sys 1= 0.000), (Pdys 3 - dys1=0.004), but not significant within A/N group; (Psys 3 – sys 1= 0.200), (Pdys 3 - dys1=0.071). No significant difference was found between both groups.
Systolic day time AMBP was statistically reduced in A/N group only ;( Sys 3 – Sys1= - 4.9± 10.2, P= 0.001) without difference between both groups. Reduction in night readings was not significant between both groups but significant within each group.
Mean changes in AVR through visits were statistically significant in each group but not when comparing both groups to each other. Improvement in nocturnal dipping stage was comparable between both groups.
Eight patients in A/V group had mild LL edema and four patients in A/N group. One patient in A/N group had headache while A/V group reported in two patients. A case of mild rash reported on visit 3 in A/N group only.
Conclusions
The combination therapy amlodipine/nebivolol 10/5mg A/N affords a significant reduction in central BP, peripheral BP and PWV with tolerable side effects. Improvement in blood pressure variability and nocturnal dipping after 10-12 weeks of treatment was significant. Amlodipine/ nebivolol 10/5mg A/N provided comparable results to the well-known amlodipine/valsartan A/V combination therapy.