The role of nebivolol in the management of hypertensive patients: from pharmacological profile to treatment guidelines

According to the most recent international guidelines, β-blockers maintain a central role in the management of hypertension, being recommended at any treatment step when there is a specific indication, such as heart failure, angina, postacute myocardial infarction, atrial fibrillation or pregnancy. However, β-blockers are not a homogeneous class: individual molecules differ in terms of pharmacological and clinical profile and are therefore suitable for different patient subtypes. In particular nebivolol, a third generation β₁-selective β-blocker with vasodilating properties, neutral metabolic effects and good tolerability, proved to have advantages over other β-blockers, which makes the drug suitable in a wide variety of hypertensive patients with or without comorbidities.

Detection of hypertrophic cardiomyopathy is improved when using advanced rather than strictly conventional 12-lead electrocardiogram

INTRODUCTION

Twelve-lead electrocardiogram (ECG) is used to screen for hypertrophic cardiomyopathy (HCM), but up to 25% of HCM patients do not have distinctly abnormal ECGs, whereas up to 5% to 15% of healthy athletes do. We hypothesized that an approximately 5-minute resting advanced 12-lead ECG test ("A-ECG score") could detect HCM with greater sensitivity than pooled conventional ECG criteria and distinguish healthy athletes from HCM with greater specificity.

MATERIALS AND METHODS

Five-minute 12-lead ECGs were obtained from 56 HCM patients, 56 age/sex-matched healthy controls, and 69 younger endurance-trained athletes. Electrocardiograms were analyzed using recently suggested pooled conventional ECG criteria and also A-ECG scoring techniques that considered results from multiple advanced and conventional ECG parameters.

RESULTS

Compared with pooled criteria from the strictly conventional ECG, an A-ECG logistic score incorporating results from just 3 advanced ECG parameters (spatial QRS-T angle, unexplained portion of QT variability, and T-wave principal component analysis ratio) increased the sensitivity of ECG for identifying HCM from 89% (78%-96%) to 98% (89%-100%; P = .025), while increasing specificity from 90% (83%-94%) to 95% (92%-99%; P = .020).

CONCLUSIONS

Resting 12-lead A-ECG scores that are simultaneously more sensitive than pooled conventional ECG criteria for detecting HCM and more specific for distinguishing healthy athletes and other healthy controls from HCM can be constructed. Pending further prospective validation, such scores may lead to improved ECG-based screening for HCM.