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Nebivolol as a first-line antihypertensive: a justifiable proposal?
  1. Lieng H Ling1,
  2. Vernon M S Oh2
  1. 1Department of Cardiology, National University Heart Centre, Singapore, Singapore
  2. 2Division of Advanced Internal Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  1. Correspondence to Dr Lieng H Ling, Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; lieng_hsi_ling{at}, mdcllh{at}

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β-Blockers (BBs) have long been used to treat hypertension (HBP). The mechanisms of their antihypertensive effects include negative chronotropy and inotropy, inhibition of β-adrenergic receptor-mediated peripheral vasoconstriction and central adrenergic outflow, as well as renin release.1 Additionally, newer BBs such as nebivolol have direct peripheral vasodilatory activity and other properties which distinguish them from first-generation and second-generation agents (table 1). In this issue of Heart Asia, Kim et al2 commend the use of BBs, and specifically nebivolol, as a first-line agent for HBP.

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Table 1

Classification, properties and cost of β-blockers available at National University, Singapore

The potential advantages of nebivolol should be considered in the context of the totality of evidence regarding the net benefits of BBs in HBP. In aggregate, the data from landmark clinical trials, systematic reviews and meta-analyses indicate that BBs are less effective than other major drug classes, in particular calcium ion-channel blockers (CCBs), in preventing stroke or cardiovascular events.5–9 Among the authoritative guidelines, the 2014 …

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