beta-Adrenoceptor antagonists (beta-blockers) have historically been considered an effective and safe option for first-line treatment of
hypertension. However, very recently, it has been proposed that beta-blockers should no longer be considered suitable for first-line
therapy in the patient with uncomplicated
hypertension because of unfavourable morbidity and mortality data. New evidence from recent clinical studies of
nebivolol, a third-generation highly selective beta(1)-blocker with additional endothelial
nitric oxide (NO)-mediated vasodilating activity, confirms previous findings that this
drug differs from other beta-blockers. The combined mechanisms of beta-
adrenoceptor antagonism and NO-mediated vasodilation may potentiate the blood pressure-lowering effect of this agent, and confer a broader favourable metabolic profile, which may be clinically relevant for hypertensive patients. The
antioxidant properties of
nebivolol and its neutral or even favourable effects on both
carbohydrate and lipid metabolism are well documented. These properties consistently differentiate
nebivolol from nonvasodilating beta-blockers such as
atenolol,
metoprolol or
bisoprolol. Therapeutic indications for beta-blockers include a wide range of co-morbidities found in hypertensive patients, including ischaemic
heart disease,
tachyarrhythmias and
heart failure. Given that the majority of hypertensive patients require more than one
drug to control blood pressure, the multiple mechanisms of action and favourable metabolic profile of
nebivolol could make it an alternative therapeutic option for hypertensive patients requiring beta-
adrenoceptor therapy.