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PP.21.24: DIFFERENTIAL 24-HOUR AMBULATORY HEMODYNAMIC EFFECTS OF NEBIVOLOL AND VALSARTAN ALONE AND IN COMBINATION

Objective: We compared an angiotensin receptor blocker (Valsartan, V), a beta-blocker (Nebivolol, N) and the combination (N/V) to determine their relative effects on 24-hour ambulatory hemodynamics. This pre-specified secondary analysis was performed as part of a study on ambulatory cardiac work. Figure. No caption available. Design and method: Subjects with hypertension (SBP > 140 or DBP > 90, n = 26) were studied with a double-blinded, forced-titration, sequence-controlled, crossover design with 3 experimental periods: V 320, N 40, and N/V 320/40 mg daily. After 4 weeks of each drug, ambulatory pulse wave analysis (IEM MobilOGraph) was performed with readings every 20 min for 24 hours. Results: Mean values for 24-hour brachial and central systolic BP values were similar with all treatments; other results (mean, SD) are shown in the Table. Compared to V, N caused lower heart rate and cardiac output (CO) but increased stroke volume (SV), systemic vascular resistance (SVR), forward and backward wave magnitude (FW and BW), and augmentation index (AI); pulse wave velocity (PWV) was not different between N and V. Hemodynamic values for N/V were very similar to N and differed from V by similar amounts as N. Conclusions: 1. Ambulatory 24-hour hemodynamic monitoring is feasible using pulse wave analysis (IEM MobilOGraph). 2. N and V have different hemodynamic profiles: N lowers heart rate and CO but increases SV, SVR, FW, BW, and AI. 3. Beta-blocker effects predominate because N/V values are similar to N monotherapy; in this design, the effects of reduced heart rate cannot be separated from specific properties of the drug.