Nebivolol is a 3rd-generation, highly β1-selective beta-blocker with nitric oxide–mediated vasodilatory effects.

Unlike Carvedilol or Labetalol, nebivolol does NOT block alpha-1 receptors.

Classification: • 3rd Generation (Vasodilating) • Highly β1 selective • Nitric oxide–mediated vasodilation • No intrinsic sympathomimetic activity (ISA)

→ Beta-Blockers Overview

Blocks:

• β1 receptors → ↓ Heart rate, ↓ contractility, ↓ renin

Additionally:

• Stimulates endothelial nitric oxide release • Causes vasodilation • Lowers systemic vascular resistance

Net Effects:

• ↓ Cardiac output • ↓ SVR • ↓ Blood pressure

This combination makes nebivolol both cardioselective and vasodilatory.

• Approved for primary hypertension • Well tolerated • Often chosen for younger patients

→ Hypertension Module

• Not a guideline-directed mortality-reducing agent in U.S. guidelines • Some European data (SENIORS trial) suggests benefit in elderly patients

Primary mortality agents remain:

• Carvedilol • Metoprolol Succinate • Bisoprolol

→ Heart Failure Module

• Highly β1 selective • Lower bronchospasm risk • Less metabolic disturbance • Vasodilation without alpha-1 blockade • Lower incidence of erectile dysfunction (compared to older agents)

• Bradycardia • Hypotension • Fatigue • Dizziness

Less CNS penetration than highly lipophilic agents like Propranolol.

• Severe bradycardia • High-grade AV block (without pacemaker) • Cardiogenic shock • Acute decompensated heart failure

Use caution in: • Severe hepatic impairment • Hypotension

Carvedilol: • Alpha-1 blockade • Mortality benefit in HFrEF

Labetalol: • Alpha-1 blockade • Used in hypertensive emergencies and pregnancy

Nebivolol: • NO-mediated vasodilation • Highly β1 selective • Primarily used for hypertension

✔ 3rd-generation vasodilating beta-blocker ✔ Highly β1 selective ✔ Vasodilation via nitric oxide ✔ Not core HFrEF mortality agent ✔ Often better tolerated metabolically

Related:

→ Beta-Blockers Overview → Hypertension Module → Heart Failure Module → Return to Cardiovascular Modules