Blood pressure effects of combined β-blocker and angiotensin-converting enzyme inhibitor therapy compared with the individual agents: A placebo-controlled study with nebivolol and lisinopril

Abstract

J Clin Hypertens (Greenwich). 2012; 14:588-592. © 2012 Wiley Periodicals, Inc. Blood pressure (BP) reductions when combining blockers of the renin-angiotensin system (RAS) and β-blockers have generally not been shown to be greater than for individual agents, possibly because of overlapping mechanisms of action. The authors tested the additivity of the β-blocker nebivolol, which has vasodilating activity, with the angiotensin-converting enzyme inhibitor lisinopril in patients with stage 2 diastolic hypertension. The BP effects of placebo (n=93), nebivolol 5mg to 20mg daily (n=185), lisinopril 10mg to 40mg daily (n=189), and nebivolol 5mg to 20mg+lisinopril 10mg to 40mg (n=189) during 6weeks of treatment were compared. The primary end point was change in diastolic BP (DBP). For the full cohort, baseline BP was 163.8/104.4mmHg, mean age was 49.2 years, 58% were men, 62% were white, and 34% were black. DBP fell by 17.2±10.2 mmHg with the combination, greater than placebo (8.0±9.2, P