The Effectiveness And Tolerability Of Nebivolol Versus Second-generation β-Blocker For Essential Hypertension:a Meta-Analysis

Objective To systematically review the efficacy and Tolerability of nebivolol versus second-generation β-Blocker(atenolol, metoprolol, bisoprolol) in the management of artery hypertension.Methods Web database as PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched for relevant studies from the inception to September 2014. According to the inclusion and exclusion criteria, two reviewers screened the literature by reading the title and the abstract, then perused the full-text of the remainder before inclusion, then quality of the included studies were assessed using the RCT scale which were recommended by the Cochrane handbook 5.1.0. Measurement data were analyzed by means of mean difference(MD) and 95%CI, enumeration data were analyzed by means of odds ratio(OR) and 95%CI. I2 and P were used to indicate heterogeneity, it is assumed that there is no or a relatively small heterogeneity if I2≤50% and P≥0.1, fixed-effects model was used to conduct meta-analysis in that case, and that there is heterogeneity if I2>50% and P<0.1, random-effects model was used in that case, the source of the heterogeneity was retrospected and subgroup test was conducted if nedded. After the data was correctly logged, RevMan 5.3 software was used to conduct the meta-analysis.Results 9 trials encompasses 1069 patients were included. The results of this thesis showed that there’s no significant difference in systolic pressure between nebivolol and second-generation P-blocker (P>0.05), nebivolol is better in the reduction of diastolic pressure[MD=0.77,95%CI(0.130,1.420), P=0.02)] and have a lower impact of heart rate in Asian patients[MD=-4.06,95%CI(-5.33,-2.78), P<0.00001)]; Nebivolol also significantly elevate the level of serum high-density lipoprotein-c[MD=3.89,95%CI(2.97,4.81), P<0.00001)], but there is no significant difference in the level of serum low-density lipoprotein-c and blood glucose (P>0.05). In addition, the incidence of drug related adverse events was lower in the nebivolol group[OR=0.55,95%CI(0.330,0.94), P=0.03].Conclusion Nebivolol is an effective as well as safety anti-hypertension drug, especially for the patients that have a highly diastolic pressure, but as the fact that the cases which is qualified to be included in our study is very rare, the result is yet to be verified.