Nebivolol in the treatment of arterial hypertension: From pharmacological profile to clinical recommendations for treatment

β-blockers are a valuable class of antihypertensive drugs, which is confirmed in modern guidelines for the treatment of hypertension. However, β-blockers are not a homogeneous class and differ in their pharmacological and clinical profile. Nebivolol is a representative of the third generation of β-blockers with the highest selectivity, additional vasodilatory and pleiotropic effects, neutral metabolic effects and good tolerability, and has proven its advantages over other β-blockers. The additional vasodilatory effect of nebivolol is mediated by NO-releasing activity with an increase in the bioavailability of NO, which is involved not only in the antihypertensive activity, but also provides important vascular protective effects. Studies demonstrate its effect on oxidative stress, endothelial dysfunction and arterial stiffness, as well as a decrease in central aortic pressure and reflected wave in patients with hypertension. Nebivolol reduces ultrastructural changes in the myocardium and coronary bed, reducing interstitial fibrosis and improving diastolic relaxation of the myocardium. Meta-analyses of clinical trials have noted the high antihypertensive efficacy of nebivolol compared to other β-blockers and other classes of antihypertensive drugs, as evidenced by a lower frequency of discontinuation and switching to other drugs. In large-scale studies of real-world clinical practice on large cohorts of patients with hypertension, nebivolol showed favorable long-term efficacy in terms of impact on cardiovascular outcomes compared to other β-blockers (atenolol, metoprolol). Thus, nebivolol has special pharmacological properties, providing additional vasodilator, antioxidant and anti-ischemic effects, which is of particular interest to certain groups of patients, in whom its good tolerability profile can also improve treatment adherence.