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Hypertension treatment in the Asia-Pacific: the role of and treatment strategies with nebivolol
  1. Cheol-Ho Kim1,
  2. Nelson Abelardo2,
  3. Peera Buranakitjaroen3,
  4. Rungroj Krittayaphong3,
  5. Chin Hock Lim4,
  6. Sung-Ha Park5,
  7. Nguyen Vinh Pham6,
  8. Gregorio Rogelio7,
  9. Bernard Wong8,
  10. Lip Ping Low9
  1. 1Department of Internal Medicine, Seoul National University, Seongnam-si, Korea
  2. 2College of Medicine, University of the Philippines College of Medicine, Metro Manila, Philippines
  3. 3Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  4. 4C H Lim Cardiology Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore
  5. 5Division of Cardiology, Severance Cardiovascular Hospital—Yonsei University College of Medicine, Seoul, Korea
  6. 6Tam Duc Heart Hospital, Ho Chi Minh City, Vietnam
  7. 7Heart Institute, St. Luke's Medical Center Global City, Metro Manila, Philippines
  8. 8Everhealth Medical Centre Limited, Hong Kong, Hong Kong
  9. 9Low Cardiology Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore
  1. Correspondence to Professor Cheol-Ho Kim, Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; cheolkim{at}plaza.snu.ac.kr; cheolkim{at}snu.ac.kr

Abstract

Hypertension is a common disease, and hypertensive patients are at increased risk of cardiovascular events. The prevalence and socioeconomic burden of hypertension in the Asia-Pacific region are predicted to increase in the coming decades. Effective blood pressure lowering reduces overall cardiovascular morbidity and mortality in patients, yet doubt has been raised regarding the use of (mainly older generation) β-blockers as initial therapy in hypertension. Consequently, several international treatment guidelines do not recommend β-blockers for the treatment of hypertension. However, in contrast to first-generation and second-generation β-blockers, the third-generation, vasodilating β-blocker nebivolol has a considerably better metabolic, haemodynamic and side effect profile. In addition to providing effective blood pressure control similar to other β-blockers and drugs from other antihypertensive classes, nebivolol exerts a dual mechanism for increasing the bioavailability of the naturally occurring vasodilator nitric oxide. The clinical benefits and significance of enhancing nitric oxide levels in hypertensive patients have been shown in direct comparisons of nebivolol with other β-blockers. While β-blockers generally provide comparable blood pressure reductions, only nebivolol demonstrated enhanced vasodilation and blood flow by increasing the expression of endothelial nitric oxide synthase and therefore increasing nitric oxide release from the endothelium. In contrast to other β-blockers, therefore, it has been suggested that nebivolol has beneficial effects in several hypertensive subgroups due to its vasodilating properties. Considering the existing data, it may be timely for treatment guidelines to recommend third-generation vasodilating β-blockers as a first-line option for the pharmacotherapy of hypertension.

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