Speakers

Prof. Claudio Ferri
University of L’Aquila, Italy

His career developed at the Rome University “La Sapienza”, where he started to publish his relevant papers on the pathophysiology of sodium homeostasis in hypertension, firstly with his research group and then in collaboration with several researchers worldwide.

At the beginning of this century, Claudio Ferri was continuing in his studies and became firstly Associate and then Full Professor of Internal Medicine at the University of L’Aquila, where he is currently Director of the Division of Internal Medicine and Nephrology – ESH Center for Hypertension and Cardiovascular Prevention.

In the last decade, Claudio Ferri was the President of the Italian Society of Hypertension and is currently the President of its Scientific Council.

He wrote hundreds of peer reviewed papers, mainly in the field of hypertension and cardiovascular prevention, with an H index = 60 on Scopus. He is also the co-author of different books, either for medical students or residents, and commonly co-write informative papers for patients and their families, the most recent one being the educational leaflet on physical activity and cardiovascular prevention that has been published by the Italian Department of Health.

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Abstract

The role of beta-blockers in the management of hypertensive patients: from pharmacological profile to treatment guidelines

The best strategy to reduce hypertension-related cardiovascular risk remains blood pressure lowering, through the use of all antihypertensive drug classes: ACE-inhibitors, ARBs, β-blockers, CCBs and diuretics [1]. Despite of the efficacy of drugs, blood pressure control rates remain poor worldwide and across Europe [2], mainly due to therapeutic inertia and poor adherence to treatment [3]. Simplifying treatment algorithms and favoring single pills combinations to quickly achieve BP targets may help in improving adherence to treatment and optimizing its efficacy [4]. For this reason, the latest update of the European Society of Cardiology/European Society of Hypertension guidelines for the diagnosis and treatment of hypertension proposed simplified drug treatment algorithms with the preferred use of an ACE inhibitor or ARB, combined with a CCB and/or a thiazide/thiazide-like diuretic, as the core treatment strategy for most patients, based on evidence on the ability of these classes to reduce cardiovascular events and improve patients’ prognosis [1]. In addition, recognizing the potential advantages of β-blockers in hypertensive patients with concomitant cardiovascular pathologies (HF, CHD and/or AF), current guidelines recommend their preferential use in these patients, in order to maximize treatment efficacy and tolerability [1]. Among β-blockers, third generation cardio-selective drugs with vasodilating and anti-oxidant properties, such as nebivolol, may show particular benefits, thanks to ancillary actions that go beyond the blockade of adrenergic receptors, to provide a better cardiovascular protection associated with a positive metabolic profile [1]. The efficacy and tolerability of nebivolol have been demonstrated in the general hypertensive population but also in hypertensives with specific cardiovascular and non-cardiovascular comorbidities (such as diabetes, COPD or erectile dysfunction) [5–7]. In keeping to this, the protective role of nebivolol is widely cited in some recent papers, clearly indicating that the Hypertension guideline downgrading of beta-blockers is not justified [8,9]. We fully agree with these comments and – as far as nebivolol is concerned – are convinced that its protective role should lead to its more wide use in the hypertensive patient, either alone or as fixed combination.  

References

  1. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36(10), 1953–2041 (2018).
  2. Chow CK, Teo KK, Rangarajan S et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 310, 959–968 (2013).
  3. Corrao G, Parodi A, Nicotra F et al. Better compliance to antihypertensive medications reduces cardiovascular risk. J. Hypertens. 29, 610–618 (2011).
  4. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 55, 399–407 (2010).
  5. Van Bortel LM. Efficacy, tolerability and safety of nebivolol in patients with hypertension and diabetes: a post-marketing surveillance study. Eur. Rev. Med. Pharmacol. Sci. 14(9), 749–758 (2010).
  6. Cazzola M, Matera MG, Ruggeri P et al. Comparative effects of a two-week treatment with nebivolol and nifedipine in hypertensive patients suffering from COPD. Respiration 71(2), 159–164 (2004). • A pilot study demonstrating the safety of nebivolol in hypertensive patients with chronic obstructive pulmonary disease.
  7. Sharp RP, Gales BJ. Nebivolol versus other beta blockers in patients with hypertension and erectile dysfunction. Ther. Adv. Urol. 9(2), 59–63 (2017).
  8. Esler M, Kjeldsen SE, Pathak A, Grassi G, Kreutz R, Mancia G. Diverse pharmacological properties, trial results, comorbidity prescribing and neural pathophysiology suggest European hypertension guideline downgrading of beta-blockers is not justified. Blood Press. 2022;31(1):210-224.
  9. Mancia  G, Kjeldsen  SE, Kreutz  R, Pathak  A, Grassi  G, Esler  M. Individualized Beta-Blocker Treatment for High Blood Pressure Dictated by Medical Comorbidities: Indications Beyond the 2018 European Society of Cardiology/European Society of Hypertension Guidelines. Hypertension. 2022;79(6):1153-1166.
  10. Ferri C. The role of nebivolol in the management of hypertensive patients: from pharmacological profile to treatment guidelines. Future Cardiol. 2021;17(8):1421-1433

 

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