The Effect of Nebivolol in Hypertensive Patients With Coronary Arterial Spasm
The Effect of Nebivolol in Hypertensive Patients With Coronary Arterial Spasm
The correlation between endothelial dysfunction and the risk of coronary heart disease is
 well known through previous studies. The degradation of the function of nitric oxide acting
 on the endothelium of blood vessels is mainly explained by reduction of synthesis, loss due
 to oxidative stress, and decreased sensitivity to vascular dilatation action. In particular,
 patients with high blood pressure have been known to have impaired vascular endothelial
 function through animal experiments and several clinical studies, mainly due to increased
 biomechanical friction in the blood vessels and decreased biological availability of nitric
 oxide, which in turn causes incongruity in the production of nitric monoxide and changes in
 normal vascular dilatation. There have also been reports recently that early diagnosis and
 treatment may improve endothelial dysfunction and prevent the progression of coronary artery
 disease. However, the reality is that the drugs available in vasospastic angina patients with
 endothelial dysfunction are very limited. Until recently, beta-blockers were reported to
 inhibit vascular dilatation of adrenaline stimuli, a drug corresponding to relative
 contraindications in vasospastic angina patients, with one study reporting that propranolol
 cannot, but rather exacerbates, vasospastic angina. However, a series of reports on the
 vascular dilatation of the recently developed third-generation beta-blockers have reinvented
 the role of beta-blockers in vasospastic angina, especially nebivolol (selective, continuous
 beta-blockers) is known to act on β-1 adrenaline receptor blockings and endothelium to create
 vascular dilatation, and also to stimulate β-3 adrenaline receptors to cause nitric oxide
 generation and antioxidant effects in the endothelium of blood vessels. Therefore, this
 clinical trial seeks to find whether nebivolol will inhibit vascular contraction in
 hypertensive patients and will work in angiospastic angina patients.
Inclusion Criteria:

 -  hypertension (stage I-2: Systolic blood pressure 140-179mmHg and diastolic blood
 pressure 90-109mmHg)

 -  20 to 80 years old

 -  diagnosed with vasospastic angina through coronary angiography and provocation test

 -  available to outpatient treatment

 -  voluntarily signed a written consent to participate in the clinical trial

 Exclusion Criteria:

 1. Previous history of hypersensitivity to beta blockers or calcium channel blockers

 2. History of dementia or accompanying psychiatric illness or history of drug abuse

 3. Those who participated in other clinical trials within 1 month before screening

 4. A person who is unable to perform compliance with the plan and procedures, or who has
 been judged by the tester to be in a medical condition inappropriate for participation

 5. Study subjects who are taking drugs that can affect the study drug efficacy evaluation
 (ACE inhibitors, angiotensin blockers, beta blockers other than clinical trial drugs,
 calcium antagonists other than clinical trial drugs, diuretics other than indapamide).
 These subjects are allowed to participate after a wash-out period of at least 2 weeks

 6. Malignant hypertension (with retinal hemorrhage or papilledema) or known moderate or
 severe retinopathy (retinal hemorrhage within the last 6 months, visual disturbance,
 retinal microaneurysm)

 7. A history of secondary hypertension and all suspected secondary hypertension:
 coarctation of the aorta, hyperaldosteronism, renal artery stenosis, Cushing's
 disease, chromatin-positive cell tumor, polycystic kidney disease, etc.

 8. Patients with orthostatic hypotension with symptoms

 9. Patients with severe heart disease (heart failure New York Heart Association class 3
 and 4), recent 6-month ischemic heart disease (angina pectoris, myocardial
 infarction), percutaneous coronary intervention, or coronary artery bypass surgery)

 10. Patients with severe cerebrovascular disease (stroke, cerebral infarction, cerebral
 hemorrhage within the last 6 months)

 11. Patients with anuria or severe renal failure (creatinine clearance <30 mL / min)

 12. Severe liver failure or AST or ALT> 3 times the upper limit of normal, biliary
 obstruction, biliary cirrhosis, cholestasis

 13. Gastrointestinal diseases and surgery patients that may affect the absorption,
 distribution, metabolism, and excretion of drugs, current active gastritis and
 gastrointestinal / rectal bleeding that the tester considers clinically significant,
 active inflammatory bowel syndrome within the last 12 months

 14. Pregnant and lactating women, those who have a pregnancy plan during the trial and do
 not agree with the appropriate method of contraception