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

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. © The Author(s) 2025. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved.