Nebivolol hydrochloride is used alone or in combination with other classes of antihypertensive agents in the management of hypertension. Although β-adrenergic blocking agents (β-blockers) were previously considered a drug of choice for the initial management of hypertension, most current guidelines no longer recommend these drugs as first-line therapy because of the lack of established superiority over other recommended drug classes and at least one study demonstrating that they may be less effective than angiotensin II receptor antagonists in preventing cardiovascular death, myocardial infarction, or stroke. However, β-blockers may still be considered in hypertensive patients who have a compelling indication (e.g., prior myocardial infarction, ischemic heart disease, heart failure) for their use or as add-on therapy in those who do not respond adequately to the preferred drug classes (angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor antagonists, calcium-channel blockers, and thiazide diuretics). and in
Efficacy of nebivolol in the treatment of hypertension has been established in several placebo-controlled studies of 12 weeks' duration in patients with mild to moderate hypertension. In these patients, usual dosages of nebivolol (5-40 mg once daily) as monotherapy decreased placebo-controlled seated systolic blood pressure by about 2.6-11.7 mm Hg and diastolic blood pressure by about 3.2-8.3 mm Hg. In patients whose blood pressure was inadequately controlled by an ACE inhibitor, angiotensin II receptor antagonist, and/or a thiazide diuretic, addition of nebivolol (5-20 mg daily) to the existing antihypertensive regimen resulted in further reductions in blood pressure. Although nebivolol monotherapy reduced blood pressure in black patients, the magnitude of the effect was somewhat smaller in black patients than in Caucasian patients.
In general, black hypertensive patients tend to respond better to monotherapy with thiazide diuretics or calcium-channel blocking agents than to monotherapy with ACE inhibitors, angiotensin II receptor antagonists, or β-blockers. Although β-blockers have lowered blood pressure in all races studied, monotherapy with these agents has produced a smaller reduction in blood pressure in black hypertensive patients; however, this population difference in response does not appear to occur during combined therapy with a β-blocker and a thiazide diuretic. and in Comparative studies are needed to determine the relative efficacy of nebivolol and other β-blockers for controlling blood pressure in black patients.
Nebivolol is at least as effective in the management of hypertension as other β-blockers (e.g., atenolol, bisoprolol, metoprolol), calcium-channel blocking agents (e.g., nifedipine, amlodipine), ACE inhibitors (e.g., lisinopril, enalapril), and angiotensin II receptor antagonists (e.g., losartan).