Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial.

Abstract

AIM:

To determine the safety and efficacy of nebivolol in elderly heart failure (HF) patients with renal dysfunction.

METHODS AND RESULTS:

SENIORS recruited patients aged 70 years or older with symptomatic HF, irrespective of ejection fraction, and randomized them to nebivolol or placebo. Patients (n = 2112) were divided by tertile of estimated glomerular filtration rate (eGFR). Mean age of patients was 76.1 years, 35% of patients had an ejection fraction of >35%, and 37% were women resulting in a unique cohort, far more representative of clinical practice than previous trials. eGFR was strongly associated with outcomes and nebivolol was similarly efficacious across eGFR tertiles. The primary outcome rate (all-cause mortality or cardiovascular hospital admission) and adjusted hazard ratio for nebivolol use in those with low eGFR was 40% and 0.84 (95% CI 0.67-1.07), 31% and 0.79 (0.60-1.04) in the middle tertile, and 29% and 0.86 (0.65-1.14) in the highest eGFR tertile. There was no interaction noted between renal function and the treatment effect (P = 0.442). Nebivolol use in patients with moderate renal impairment (eGFR <60) was not associated with major safety concerns, apart from higher rates of drug-discontinuation due to bradycardia.

CONCLUSION:

Nebivolol is safe and has a similar effect in elderly HF patients with mild or moderate renal impairment.

• Authors: Alain Cohen-Solal, Dipak Kotecha, Dirk J van Veldhuisen, Daphne Babalis, Michael Böhm, Andrew J Coats, Michael Roughton, Philip Poole-Wilson, Luigi Tavazzi, Marcus Flather, SENIORS Investigators
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 11 Issue 9 Pg. 872-80 (Sep 2009) ISSN: 1879-0844 [Electronic] England
• PMID: 19648605 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenergic beta-Antagonists
• Benzopyrans
• Ethanolamines
• Vasodilator Agents
• Nebivolol
• Creatinine

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Age Factors
• Aged
• Aged, 80 and over
• Analysis of Variance
• Benzopyrans (therapeutic use)
• Confidence Intervals
• Creatinine (blood, urine)
• Ethanolamines (therapeutic use)
• Female
• Glomerular Filtration Rate
• Heart Rate
• Humans
• Kidney (drug effects)
• Kidney Diseases
• Male
• Multivariate Analysis
• Nebivolol
• Stroke Volume (drug effects)
• Vasodilator Agents (therapeutic use)
• Ventricular Function, Left (drug effects)