Posttreatment pulse rate reduction and not baseline pulse rate as an indicator of blood pressure response to nebivolol: a subanalysis from the real-world BENEFIT-KOREA study

Abstract

Background: This subanalysis of BENEFIT-KOREA cohort assessed the impact of baseline pulse rate (PR) and posttreatment PR reduction on the blood pressure (BP)-lowering efficacy of nebivolol in patients with hypertension. Methods: South Korean patients with hypertension were enrolled in the BENEFIT-KOREA study; 3,011 patients received nebivolol as monotherapy/add-on therapy. Time-averaged BP, calculated by sum of the product of BPs at weeks 12 and 24 corrected for number of participants at these timepoints, was evaluated with/without adjustment for baseline BP. Change in BP in baseline PR groups of < 70, 70–79, and ≥ 80 beats/min and posttreatment PR reduction groups of < 1, 1–9, and ≥ 10 beats/min at 24 weeks were evaluated. Results: The unadjusted time-averaged systolic BP (SBP) at 24 weeks was not significantly different within baseline PR groups or posttreatment PR reduction groups, but the unadjusted time-averaged diastolic BP (DBP) was significantly different within both baseline PR (P < 0.001) and posttreatment PR reduction groups (P < 0.001). Significant differences were observed in adjusted time-averaged SBP (≥ 10 beats/min group: β, −3.4148; P = 0.006) and time-averaged DBP (≥ 10 beats/min: β, −4.5781; P < 0.001) only within the posttreatment PR reduction groups. The majority of adverse events reported with nebivolol were mild. Conclusions: The efficacy of nebivolol for BP reduction seems to be indicated not by baseline PR but by posttreatment PR reduction. These findings suggest the presence of other mechanisms in addition to sympathetic inhibition which potentially weaken the relationship between baseline PR and BP reduction. Trial Registration: ClinicalTrials.gov Identifier: NCT03847350