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Cardiovascular complications (left ventricular hypertrophy, atrial fibrillation, heart failure, coronary events, increased arterial stiffness and atherosclerotic lesions) are the major causes of death among patients with hypertension. Oxidative stress and central aortic pressure play a key role in the pathophysiology of the cardiovascular diseases and complications. Antihypertensive agents may, even within the same class of drugs, exert variable effects on arterial stiffness parameters and endothelial function. Nebivolol is a third-generation β-blocker with vasodilator activity. Its vasodilatory function is mediated by the endothelial L-arginine/NO pathway. Nebivolol increases the bioavailability of NO in the vasculature. Recent studies have demonstrated that nebivolol improves arterial stiffness to a greater extent than conventional β-adrenolytics (atenolol, metoprolol). According to ESH/ESC guidelines, some of the vasodilating β-adrenolytics, such as celiprolol, carvedilol and nebivolol, provide greater reduction in central pulse pressure and aortic stiffness than atenolol or metoprolol.

Protective effect of nebivolol to prevent target organ damage in hypertension