Nebivolol and incident cardiovascular events in hypertensive patients compared with nonvasodilatory beta blockers

Objective: Nonvasodilatory beta blockers are associated with inferior cardiovascular event reduction compared with other antihypertensive classes, and there is uncertainty about first-line use of beta blockers for hypertension in guidelines. The third generation vasodilatory beta blocker nebivolol has unique beneficial effects on central and peripheral vasculature. Our objective was to compare longitudinal cardiovascular outcomes of hypertensive patients taking nebivolol with those taking the nonvasodilatory beta blockers metoprolol and atenolol. Methods: We performed a retrospective cohort analysis of hypertensive adults in the University of Colorado health system, without preceding diagnosis of cardiovascular or cerebrovascular disease. The primary outcome was composite incident heart failure, stroke, myocardial infarction, angina, or coronary revascularization. Mahalanobis 1:2 distance matching and Cox proportional hazards regression was used. Matching and regression variables included baseline demographics, socioeconomic factors, medical insurance type, prescribing provider type, cardiovascular risk factors, Charlson comorbidity index, other medications, and follow-up duration. Results: After matching, patients were predominantly women (54%, 3085 of 5705) and non-Hispanic Caucasian (79%, 4534 of 5705), with median age of 58. In matched Cox regression analysis, nebivolol was associated with 17% reduction in incident cardiovascular events compared with all nonvasodilatory beta blockers [hazard ratio 0.83, 95% confidence interval (CI) 0.74-0.94, P= 0.004], and 24% reduction compared with metoprolol (hazard ratio 0.76, CI 0.66-0.87, P = 0.0001). Conclusion: The vasodilatory beta blocker nebivolol was associated with reduced incident cardiovascular events compared with nonvasodilatory beta blockers. Additional study of other beta blockers is necessary to determine if this is a vasodilatory beta blocker class effect or is specific to nebivolol.

Automated summary

Compared with nonvasodilatory beta blockers, the vasodilatory beta blocker nebivolol is associated with reduced incidence of cardiovascular events.