Reversal of subclinical left ventricular dysfunction by antihypertensive treatment: a prospective trial of nebivolol against metoprolol.

Objectives: To assess the effects of antihypertensive treatment on subclinical left ventricular dysfunction and to compare the effects of nebivolol with metoprolol. Methods: This is a prospective, randomized, parallel, active-controlled, PROBE design study (ClinicalTrials.org: NCT00942487) in 60 patients (53 ± 9 years, 67% men) with arterial hypertension, left ventricular hypertrophy, normal ejection fraction, and no coronary heart disease, randomized to either a nebivolol-based or a metoprolol-based treatment, who had conventional and tissue Doppler echocardiography, at rest and during dobutamine stress, at baseline and after 6 months. Results: SBP and DBP, and resting heart rate decreased by 13, 13, and 12%, respectively, on nebivolol, and by 11, 13, and 7%, respectively, on metoprolol (all, P < 0.01). Mean longitudinal early diastolic velocity increased by 16% (P < 0.05) on nebivolol compared with 9% (P = not significant) on metoprolol (P = not significant for intergroup differences), whereas flow propagation velocity increased by 34% on nebivolol (P < 0.05) and did not change on metoprolol (P < 0.01 for intergroup differences). Mean longitudinal displacement increased by 10% on nebivolol (P < 0.05) and did not change on metoprolol (P < 0.05 for intergroup differences), whereas ejection time increased by 5% on nebivolol (P < 0.05) and did not change on metoprolol. All the other parameters of left ventricular function were not different between the two treatment arms. Conclusion: Patients with mild-to-moderate hypertension have a beneficial effect from 6-month antihypertensive treatment on diastolic longitudinal left ventricular function; effects are significant with nebivolol, but not with metoprolol.