Effects of Beta-Blockade on Exercise Performance at High Altitude: A Randomized, Placebo-Controlled Trial Comparing the Efficacy of Nebivolol versus Carvedilol in Healthy Subjects

Mariaconsuelo Valentini, Miriam Revera, Grzegorz Bilo, Gianluca Caldara, Giulio Savia, Katarzyna Styczkiewicz, Sara Parati, Francesca Gregorini, Andrea Faini, Giovanna Branzi, Gabriella Malfatto, Damiano Magrì, Piergiuseppe Agostoni, Gianfranco Parati

Research output: Contribution to journalArticle


Aims: Exposure to high altitude (HA) hypoxia decreases exercise performance in healthy subjects. Although β-blockers are known to affect exercise capacity in normoxia, no data are available comparing selective and nonselective β-adrenergic blockade on exercise performance in healthy subjects acutely exposed to HA hypoxia. We compared the impact of nebivolol and carvedilol on exercise capacity in healthy subjects acutely exposed to HA hypobaric hypoxia. Methods: In this double-blind, placebo-controlled trial, 27 healthy untrained sea-level (SL) residents (15 males, age 38.3 ± 12.8 years) were randomized to placebo (n = 9), carvedilol 25 mg b.i.d. (n = 9), or nebivolol 5 mg o.d. (n = 9). Primary endpoints were measures of exercise performance evaluated by cardiopulmonary exercise testing at sea level without treatment, and after at least 3 weeks of treatment, both at SL and shortly after arrival at HA (4559 m). Results: HA hypoxia significantly decreased resting and peak oxygen saturation, peak workload, VO 2, and heart rate (HR) (P <0.01). Changes from SL (no treatment) differed among treatments: (1) peak VO 2 was better preserved with nebivolol (-22.5%) than with carvedilol (-37.6%) (P <0.01); (2) peak HR decreased with carvedilol (-43.9 ± 11.9 beats/min) more than with nebivolol (-24.8 ± 13.6 beats/min) (P <0.05); (3) peak minute ventilation (VE) decreased with carvedilol (-9.3%) and increased with nebivolol (+15.2%) (P= 0.053). Only peak VE changes independently predicted changes in peak VO 2 at multivariate analysis (R= 0.62, P <0.01). Conclusions: Exercise performance is better preserved with nebivolol than with carvedilol under acute exposure to HA hypoxia in healthy subjects.

Original languageEnglish
Pages (from-to)240-248
Number of pages9
JournalCardiovascular Therapeutics
Issue number4
Publication statusPublished - Aug 2012



  • Adrenergic receptor blockade
  • Autonomic nervous system
  • Beta receptor
  • Cardiopulmonary exercise test
  • Carvedilol
  • Clinica trial
  • Hypoxia
  • Nebivolol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)
  • Pharmacology

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