Nebivolol Effects on Nitric Oxide Levels, Blood Pressure, and Renal Function in Kidney Transplant Patients.
Santos AHJ, Casey MJ, et al.J Clin Hypertens 2015 [record in progress].
Aims
To determine the effect of nebivolol vs metoprolol on nitric oxide (NO) blood level, estimated glomerular filtration rate (eGFR), and blood pressure (BP) in kidney transplant recipients.
Interventions
Participants were randomly assigned to receive oral treatment with either nebivolol or metoprolol
Participants
30 hypertensive recipients of a solitary kidney or combined kidney-pancreas transplant aged ≥18 years
Outcomes
The primary outcome measured was changes in blood NO level. Secondary outcomes were changes in eGFR, BP, and number of antihypertensive drug classes used.
Follow-up
12 months
CET Conclusions
Poor control of hypertension in renal transplant recipients does result in poorer long term graft outcome. In this study, the investigators have compared nebivolol, a third generation beta-blocker, with metoprolol. Nitric Oxide (NO) levels were measured over a 12-month period, this being the primary end point. In addition, they have measured blood pressure and renal function, and it should be noted that all patients were on a tacrolimus immunosuppressive regimen. Nebivolol did increase plasma Nitric Oxide levels in transplant recipients younger than 50 years, compared to metoprolol. There was no difference in blood pressure, renal function or number of antihypertensive drugs required at 12 months. Nitric Oxide reduction is related to endothelial damage and is associated with increases in blood pressure. Thus, in theory, increase in post-transplant Nitric Oxide might be beneficial. However, this is a small study with a very limited sample (30 patients, 15 in each arm) and neither patients nor investigators were blinded to the treatment being received. If this increase in Nitric Oxide is regarded as important, then a much larger trial would need to be done.
Data analysis
Strict intention-to-treat analysis
Trial registration
Clinicaltrials.gov - NCT01157234