Elderly patients with heart failure tolerated the nebivolol (Nebilet, Forest) well. In fact, 67% of 1,031 patients assigned to receive the beta blocker reached the target dose of 10 mg/day, 80% reached a maintenance dose of at least 5 mg, and approximately 70% of patients remained on the same maintenance dose until the end of the 16-week trial.
In the Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure (SENIORS), a small number of patients (7%) could not tolerate a dose of nebivolol by the end of the titration phase. Those patients tended to be older; they also had lower blood pressures, lower heart rates, higher creatinine levels, and a higher prevalence of myocardial infarction as the underlying cause of heart failure. Patients with a history of hypertension tolerated the target doses better.
When patients receiving a target dose of nebivolol were compared with patients receiving placebo, the beneficial effects of nebivolol appeared early and were constant. The 5-mg dose appeared to be as beneficial as the 10-mg dose, but the lower doses showed no benefit. However, the numbers of patients in those lowest-dose groups were too small to allow a firm conclusion.
Patients who could not tolerate a maintenance dose had the worst outcomes— double the risk of death or hospitalization for cardiovascular causes.
(Source: Am Heart J 2007;