The Effect of Nebivolol Treatment on

Endothelial and Erectile Functions

in Hypertensive Men (P 704)

Beste Ozben Sadic1, Utku Kefeli1, Altug Cincin1, Oytun Baykan1,

Ozay Ozgur2, Cem Akbal2, Yelda Basaran1, Osman Yesildag1

1 Marmara University, Faculty of Medicine, Department of

Cardiology, Istanbul, Turkey
2 Marmara University, Faculty of Medicine, Department of
Urology, Istanbul, Turkey
 NEBIVOLOL
 a third generation β-receptor antagonist

 effective in lowering blood pressure as other

beta-blockers (atenolol and bisoprolol)
 associated with a 14% reduction in all-cause
mortality and cardiovascular hospitalization at 12
months in patients with heart failure
 well tolerated relative to the other
antihypertensive agents
2
 ENDOTHELIAL DYSFUNCTION
 plays a role in every step during the atherosclerotic
process.
 All the well known risk factors including age, smoking,
hypertension, hyperlipidemia, and diabetes facilitate the
development of atherosclerosis by impairing the normal
endothelial function.
 Brachial artery flow-mediated dilation (FMD) is a well-
studied measure of endothelial function that has been
used to noninvasively assess conduit artery and
microvascular endothelial function.
 FMD has been shown useful in determining
cardiovascular risk of the patients. 3
NEBIVOLOL AND ENDOTHELIAL FUNCTION
 Nebivolol causes vasodilatation via interaction with the
endothelial L-arginine/nitric oxide (NO) pathway.
 Nebivolol inhibits the proliferation of human coronary
artery smooth muscle cells and reduces endothelin-1
secretion in human coronary endothelial cells.
 Nebivolol improves endothelial function in certain patient
populations including hypertension, diabetes, metabolic
syndrome and cardiac syndrome X.

4
 ERECTILE DYSFUNCTION
 Erectile dysfunction is a multifactorial disease
related to age, vascular disease, psychological
disorders, or medical treatments.
 Erectile dysfunction is highly prevalent in
hypertensive patients treated with beta-blockade
agents.

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NEBIVOLOL AND ERECTILE FUNCTION
 Nebivolol improved penile endothelial function as a
surrogate of erectile function in ApoE-/- mice.
 Nebivolol in vivo activated the NO/cGMP pathway,
enhanced erectile response and reversed erectile
dysfunction in diabetic rats.
 These effects may be related to a reduction of reactive
oxygen species production and may account for the low
incidence of erectile dysfunction in nebivolol-treated
hypertensive patients.
 Therefore, nebivolol may have utility in the treatment of
erectile dysfunction.
6
 THE AIM OF THIS STUDY

to evaluate the effects of nebivolol on

endothelial and erectile functions in
hypertensive male patients.

7
 PATIENTS AND METHODS
 Forty hypertensive patients who were given nebivolol
5mg/day and had complaints of erectile dysfunction were
consecutively recruited into the study.

Table 1. Characteristics of the patients

Mean age (years) 53.5 ± 10.1
Body mass index (kg/m2) 28.4 ± 3.78
Diabetes (n) 7
Hyperlipidemia (n) 22
Coronary artery disease (n) 3
Chronic renal failure (n) 1
Smoking (n) 28 8
 PATIENTS AND METHODS
 Endothelial function was assessed by brachial
arterial flow-mediated dilation (FMD).

 International Index of Erectile Functions (IIEF)

questionaire was used to assess erectile function.

 Endothelial and erectile functions of the patients

were evaluated before the nebivolol therapy and at
the first and third month of therapy.

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 RESULTS
Nebivolol significantly decreased
 the systolic blood pressure and
 heart rate of the patients at the third month of
therapy.

Baseline 1. Month 3. Month p

Systolic blood pressure 156.5 ± 18.9 143.8 ± 17.7 132.4 ±13.5 <0.001
(mmHg)

Diastolic blood pressure 83.1 ± 10.5 80.3 ± 10.9 80.1 ± 9.2 0.061
(mmHg)

Heart rate (/min) 76 ± 10 72 ± 10 70 ± 8 <0.001

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 RESULTS
 The FMD values at the third month of therapy
were both significantly higher than the basal
values.
Baseline 1. Month 3. Month p

Baseline velocity 48.25 ± 13.36 46.75 ± 11.28 46.95 ± 12.62 0.402

(cm/s)
Baseline diameter 3.98 ± 0.52 3.88 ± 0.52 3.94 ± 0.55 0.052
(mm)
Post-ischemic flow 106.49 ± 25.23 106.67 ± 28.83 115.83 ± 26.53 0.001
velocity (cm/s)

FMD absolute (mm) 0.31 ± 0.14 0.38 ± 0.16 0.46 ± 0.16 <0.001
FMD percentage (%) 7.98 ± 3.76 9.94 ± 4.44 12.14 ± 4.75 <0.001
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 RESULTS
 Nebivolol decreased the number of patients with FMD
values < 10% at the third month of therapy (26 vs 14,
p= 0.012).
30

25
p= 0.012
20

15 26
FMD < 10%
10 14

0
Baseline 3rd
Month
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 RESULTS
 Erectile function scores at the third month of
therapy were both significantly higher than the
basal values.

Baseline 1. Month 3. Month p

Erectile function 11.2 ± 7.2 13.6 ± 7.3 16.4 ± 8.5 <0.001

scores

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 RESULTS
 Nebivolol decreased the number of patients with
moderate to severe erectile dysfunction (scores ≤ 21)
at the third month of therapy (38 vs 26, p<0.001).

40
35
p<0.001
30
25
20 38 Patients with
15 26 moderate to
severe ED
10
5
0
Baseline 3rd
Month 14
 RESULTS
 Erectile function scores at the baseline and at
the third month of therapy were significantly
correlated with each other (r= 0.768, p<0.001).
 There was not any significant correlation
between FMD measures at the baseline and at
the third month of therapy.
 There was not any significant correlation
between FMD measures and erectile function
scores at the baseline and at the third month of
therapy.
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 CONCLUSIONS
 Nebivolol improved both the endothelial and
erectile dysfunction in hypertensive male
patients.

 Nebivolol might be preferred in hypertensive

patients with complaints of erectile dysfunction.

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