Efficacy and tolerability of nebivolol compared with other antihypertensive drugs: a meta-analysis

Aim: Lowering BP to normal levels without quality of life deterioration is the most important means of reducing cardiovascular risk. Recent studies have challenged the position of beta-adrenoreceptor antagonists (beta-blockers) as first-line antihypertensive drugs. Nebivolol is a third-generation, highly selective beta (1)-blocker that causes vasodilation through nitric oxide (NO) release. This meta-analysis investigates the efficacy and tolerability of nebivolol compared with other antihypertensive drugs and placebo in patients with hypertension. Methods: Twelve randomized controlled studies were included, in which nebivolol 5 mg once daily was compared with the recommended clinical doses of other antihypertensive drugs (n=9), placebo (n=2), and both (n=1). The clinical studies were selected after a MEDLINE search up to 2007, using the key words "nebivolol" and "hypertension". Results: Antihypertensive response rates (the percentage of patients achieving target BP levels or a defined DBP reduction) were higher with nebivolol than with ACE inhibitors (odds ratio [OR] 1,92; p=0,001) and all antihypertensive drugs combined (OR 1,41; p=0,001) and similar to beta-blockers, calcium channel antagonists (CCAs) and the angiotensin receptor antagonist (ARA) losartan. Moreover, a higher percentage of patients receiving nebivolol achieved target BP levels compared with patients treated with losartan (OR 1,98; p=0,004), CCAs (OR 1,44; p=0,024), and all antihypertensive drugs combined (OR 1,35; p=0,012). The percentage of patients experiencing adverse events did not differ between nebivolol and placebo; adverse event rates were significantly lower with nebivolol than losartan (OR 0,52; p=0,016), other beta-blockers (OR 0,56; p=0,007), nifedipine (OR 0,49; p < 0,001), and all antihypertensive drugs combined (OR 0,59; p < 0,001). Conclusion: Results of previous pharmacokinetic studies suggest that nebivolol 5 mg may not conform completely to the definition of a classic beta-blocker, demonstrating additional antihypertensive effect due to endothelial NO release-mediated vasodilation. This meta-analysis showed that nebivolol 5 mg achieved similar or better rates of treatment response and BP normalization than other drug classes and other antihypertensive drugs combined, with similar tolerability to placebo and significantly better tolerability than losartan, CCAs, other beta-blockers, and all antihypertensive drugs combined. Although not definitive, this meta-analysis suggests that nebivolol 5 mg is likely to have advantages over existing antihypertensives and may have a role in the first-line treatment of hypertension.