Aims: The vasodilating β-blockers (BB) have several advantages over conventional cardioselective BB atenolol in the treatment of hypertension. However, metoprolol (MET) is the most widely used cardioselective BB in Northern and Eastern European countries. The aim of the present study was to investigate the long-term effects of nebivolol (NEB) and MET on central haemodynamics, structural and functional changes of arteries, and left ventricular wall thickness.

Methods: We conducted a randomized, double-blind study in 80 hypertensive patients, who received either nebivolol 5mg or metoprolol succinate 50–00mg daily for one year. Endothelial function (Salbutamol-induced vasodilation), wave reflection (Augmentation index (AI_x)), carotid-femoral pulse wave velocity (PWV), carotid artery intima-media thickness (IMT) and left ventricular wall thickness were measured at baseline, 6 months, and 12 months of treatment.

Results: NEB and MET decreased equally brachial blood pressure (BP), whereas reduction in central pulse pressure and left ventricular wall thickness was significant only in the NEB group. Left ventricular wall thickness change was significantly related to central systolic BP change (r=0.41; P=0.001) and central pulse pressure change (r=0.32; P=0.01). No significant changes in AIx, PWV and IMT were detected in either treatment group. Endothelial function improved significantly after 6 months in the NEB treatment group.

Conclusion: Our study expands earlier observations with vasodilating BB and shows that nebivolol has a stronger impact on central blood pressure and left ventricular wall thickness reduction than metoprolol. Thus, β-blockers with vasodilating properties may offer a clear advantage over a conventional β-blocker in antihypertensive therapy.