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Differential Effects of Antihypertensive Drugs on Central Blood Pressure: A Randomized Comparison Between Nebivolol

Subin Lim^1,2, Hyungdon Kook³, Cheol Woong Yu²

¹Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.

American Journal of Hypertension

|June 10, 2025

Insights

Nebivolol was less effective than telmisartan in lowering central systolic blood pressure (cSBP) over 12 weeks in hypertensive patients. Telmisartan demonstrated superior efficacy in reducing cSBP and improving arterial stiffness markers.

Area of Science:

Cardiology
Pharmacology
Hypertension Management

Background:

Central blood pressure (CBP) is a critical predictor of cardiovascular outcomes.
Third-generation beta-blockers like nebivolol offer vasodilatory effects, potentially impacting CBP.
Previous beta-blockers showed limited CBP-lowering effects.

Purpose of the Study:

To compare the efficacy of nebivolol versus telmisartan in reducing central blood pressure (CBP) over 12 weeks.
To evaluate the impact of nebivolol and telmisartan on central systolic blood pressure (cSBP) in hypertensive patients.

Main Methods:

A prospective, randomized, multicenter, open-label trial involving 98 hypertensive participants.
Participants received either nebivolol (n=49) or telmisartan (n=49) for 12 weeks.
Primary endpoint: change in central systolic blood pressure (cSBP) at 12 weeks.

Main Results:

Telmisartan significantly reduced cSBP more than nebivolol (-29.3 mmHg vs. -17.2 mmHg).
Telmisartan significantly decreased augmentation index (AIx), indicating improved arterial stiffness, unlike nebivolol.
Nebivolol resulted in a significantly lower heart rate compared to telmisartan.

Conclusions:

Nebivolol demonstrated less efficacy in reducing central systolic blood pressure compared to telmisartan.
Telmisartan appears to be a more effective agent for lowering central blood pressure and improving arterial stiffness in this hypertensive cohort.

Read full analysis

Abstract

Background:

Central blood pressure (CBP) is a better predictor of cardiovascular outcomes than peripheral blood pressure. First- and second-generation beta-blockers have shown poor CBP-lowering effects. However, nebivolol, a third-generation beta-blocker with vasodilatory effects, may be beneficial in lowering CBP. This study compared the CBP-lowering efficacies of nebivolol and telmisartan over a 12-week period in patients with hypertension.

Methods:

This prospective, randomized, multicenter, open-label, controlled trial evaluated 98 participants with hypertension. For 12 weeks, participants received either nebivolol (n = 49) or telmisartan (n = 49) for 12 weeks with a target blood pressure of ≤140/90 mmHg for the entire period. The primary endpoint was a change in central systolic blood pressure (cSBP) after 12 weeks.

Results:

cSBP reduction at week 12 was significantly less in the nebivolol group than in the telmisartan group (-17.2 vs. -29.3mmHg; between-group difference, 12.7 mmHg; 95% confidence interval [CI], 4.1-21.2; P = 0.004). Central pulse pressure decreased in both groups; however, the difference between the groups was not significant (-8.5 vs. -14.1 mmHg, P = 0.207). The nebivolol group demonstrated a slightly increased augmentation index (AIx), whereas the telmisartan group had a significantly decreased AIx (0.7 vs. -7.3 mmHg; 95% CI, 3.1-13.0; P = 0.002). Heart rate at week 12 was significantly lower in the nebivolol group than that in the telmisartan group (64.2 ± 11 vs. 74.6 ± 11 beats per minute, P < 0.001).

Conclusions:

Nebivolol was less effective than telmisartan at reducing cSBP.

Clinical Trial Registration:

NCT05328310.

Keywords:

angiotensin receptor blocker beta-blocker blood pressure central blood pressure hypertension

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