Nebivolol: Its role in the treatment of hypertension and chronic heart failure

(beta)-blockers are standard therapy in patients with cardiovascular disease, and have become a cornerstone in the treatment of both hypertension and chronic heart failure. However, two meta-analyses have recently raised doubts about the use of (beta)-blockers in patients with essential hypertension. These concerns were mainly related to studies performed with atenolol. The mode of action of nebivolol is distinctly different from atenolol and other (beta)-blockers. Besides being a highly selective (beta)1-blocker, nebivolol also improves endothelial function and baroreflex sensitivity, and does not have any adverse effects on insulin sensitivity. In addition, its side effect profile is superior compared with other (beta)-blockers and calcium channel blockers, and comparable to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. In patients with hypertension, randomized, controlled trials demonstrated that the effects of nebivolol on reduction of blood pressure are at least similar when compared with other (beta)-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. In patients with chronic heart failure, smaller studies demonstrated beneficial effects with nebivolol on hemodynamics and left ventricular function. Moreover, a large-scale study recently demonstrated beneficial effects on mortality and morbidity in elderly chronic heart failure patients, which is the first mortality and morbidity study that specifically focused on elderly chronic heart failure patients. (copyright) 2006 Future Medicine Lt