Nebivolol as monotherapy in patients with type 2 diabetes.

Aim: The aim of this study was to examine the effect of the cadioselective B-1-adrenoceptor blocker nebivolol on glycaemic control, lipid profile and markers of oxidative stress in patients with type 2 diabetes over a 6-month period.Methods: Twenty-six patients with mild to moderate hypertension (140-160 mmHg systolic, 90-105 mmHg diastolic) confirmed on 24-h blood pressure monitoring, were treated with nebivolol 5 mg daily for 6 months. Total serum cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) subfractions, lipid hydroperoxides (LHPs) and total antioxidant capacity (TAC) were measured before and after 6 months of treatment.Results: Nebivolol, as expected, reduced mean daytime systolic and diastolic pressures on ambulatory monitoring (149 + - 9 to 140 t + - 13 mmHg, P = 0.02 and 84 + - 7 to 77 + - 9 mmHg, P 0.001). There were no significant changes in serum cholesterol or triglycerides following treatment but a significant increase in HDL cholesterol was noted (1.12 + - 0.19 to 1.25 + - 0.36 mmol L, P = 0008). Patients showed a highly significant reduction in TAC from 501 57 to 422 + - 29 trolox equivalent (P 0.001). Baseline LHPs were very high and showed no significant change over the 6-month period (18.7 + - 7.4 and 18.7 + - 10.9 mu mol L). The LDL score increased significantly from 1.7 + - 0.7 to 2.3 + - 0.7 (P = 00002) at 6 months suggesting a change to a more atherogenic lipid profile. Neither weight nor glycaemic control changed during treatment.Conclusion: Nebivolol appears to be lipid neutral and may even have a positive effect on HDL cholesterol. Despite this it may promote the formation of potentially atherogenic LDL subfractions possibly as a result of reduced antioxidant defences. Further studies are needed to clarify the changes observed in parameters of oxidative stress.