Key result
Nebivolol achieves a ~13 mmHg smaller reduction in cSBP than telmisartan.
Why the study?
Earlier-generation beta-blockers show poor central blood pressure-lowering effects, but whether nebivolol, a vasodilatory third-generation beta-blocker, effectively lowers central blood pressure compared to telmisartan was unclear.
Does nebivolol reduce central systolic blood pressure compared to telmisartan in patients with hypertension?
RCT (n=98)
Open-label
Yes
Does nebivolol reduce central systolic blood pressure compared to telmisartan in patients with hypertension?
In patients with hypertension, nebivolol was significantly less effective than telmisartan at reducing central systolic blood pressure over 12 weeks.
Answers are grounded in this paper and cite their sources.
Telmisartan preferred over nebivolol for central SBP reduction in hypertension; extends evidence that beta-blockers underperform ARBs centrally.
BACKGROUND: Central blood pressure (CBP) is a better predictor of cardiovascular outcomes than peripheral blood pressure. First- and second-generation beta-blockers have shown poor CBP-lowering effects. However, nebivolol, a third-generation beta-blocker with vasodilatory effects, may be beneficial in lowering CBP. This study compared the CBP-lowering efficacies of nebivolol and telmisartan over a 12-week period in patients with hypertension. METHODS: This prospective, randomized, multicenter, open-label, controlled trial evaluated 98 participants with hypertension. For 12 weeks, participants received either nebivolol (n = 49) or telmisartan (n = 49) for 12 weeks with a target blood pressure of ≤140/90 mmHg for the entire period. The primary endpoint was a change in central systolic blood pressure (cSBP) after 12 weeks. RESULTS: cSBP reduction at week 12 was significantly less in the nebivolol group than in the telmisartan group (-17.2 vs. -29.3mmHg; between-group difference, 12.7 mmHg; 95% confidence interval [CI], 4.1-21.2; P = 0.004). Central pulse pressure decreased in both groups; however, the difference between the groups was not significant (-8.5 vs. -14.1 mmHg, P = 0.207). The nebivolol group demonstrated a slightly increased augmentation index (AIx), whereas the telmisartan group had a significantly decreased AIx (0.7 vs. -7.3 mmHg; 95% CI, 3.1-13.0; P = 0.002). Heart rate at week 12 was significantly lower in the nebivolol group than that in the telmisartan group (64.2 ± 11 vs. 74.6 ± 11 beats per minute, P < 0.001). CONCLUSIONS: Nebivolol was less effective than telmisartan at reducing cSBP. CLINICAL TRIAL REGISTRATION: NCT05328310.
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Lim et al. (2025) conducted an RCT in Hypertension (n=98). Nebivolol vs. Telmisartan was evaluated on Change in central systolic blood pressure (cSBP) after 12 weeks (Difference 12.7 mmHg, 95% CI 4.1-21.2, p=0.004). Nebivolol was significantly less effective than telmisartan at reducing central systolic blood pressure over 12 weeks (-17.2 vs. -29.3 mmHg; between-group difference 12.7 mmHg; P=0.004).
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