Comparative Effectiveness and Outcomes of Nebivolol Versus Other Beta Blockers in Patients With Hypertension: A Multicenter Cohort Study.

BACKGROUND

Beta blockers represent an important class of antihypertensive agents, but comparative data on different beta blockers in the treatment of hypertension remain limited. Nebivolol, a third-generation beta blocker, possesses unique pharmacological properties. This study aimed to evaluate its real-world effectiveness in blood pressure and heart rate control, as well as the associated clinical outcomes in patients with hypertension.

METHODS

We conducted a retrospective review of the Chang Gung Research Database to identify patients with hypertension who were newly prescribed beta blockers-primarily nebivolol, carvedilol, and bisoprolol-between 2018 and 2023. Inverse probability of treatment weighting was applied to balance the baseline characteristics across groups. Outcomes included changes in blood pressure and heart rate, as well as the incidence of major adverse cardiovascular events.

RESULTS

We identified 99 942 patients with hypertension. After inverse probability of treatment weighting, the patients treated with nebivolol had significantly greater reductions in systolic blood pressure (-11.0 mm Hg [95% CI, -11.6 to -10.4]), diastolic blood pressure (-8.1 mm Hg [95% CI, -8.5 to -7.6]), and heart rate (-7.3 bpm [95% CI, -7.8 to -6.9]) compared with carvedilol and other beta blockers. During a mean follow-up of 4.5 years, nebivolol use was associated with a significantly lower risk of all-cause mortality (hazard ratio [HR], 0.73 [95% CI, 0.63-0.86]) and major adverse cardiovascular events (HR, 0.81 [95% CI, 0.74-0.90]).

CONCLUSIONS

In this retrospective cohort study of patients with hypertension without heart failure, nebivolol was associated with greater reductions in blood pressure and heart rate, as well as a lower risk of all-cause mortality and major adverse cardiovascular events, compared with carvedilol and other beta blockers. Although these findings suggest potential benefits of nebivolol in this population, prospective studies are needed to validate these observations.