Nebivolol in the treatment of systemic hypertension

Despite a long history of using in clinical setting and important treatment option by previous guidelines, recent guidelines has questioned the role of beta-blockers in the treatment of hypertension, and were recomended to 2nd or 3rd line positions based on the outcome of recent trials and meta-analyses. However, those studies and meta-analyses were achieved using first-generation betablockers and it should be remembered that beta-blockers are heterogenous class as having different pharmacologic and physiologic profile. The question is whether third-generation beta-blockers with vasodilatory properties could offer advantages compared to previous beta-blockers. This group has great potential for blood pressure lowering along with low metabolic side effect. Among all the beta-blockers in clinical use today, nebivolol, which has the highest selectivity for beta-1 receptors with a different pharmacodynamic and kinetic profile, has great blood pressure lowering effect both monotherapy and in antihypertensive combination therapy. Nebivolol is not only safe and well tolerated, with exerts neutral or even benefical effects on metabolic parameters, it improves quality of life in patients with hypertension. In the light of those evidence nebivolol may be considered as first-line treatment among the modern combination therapy.