Βeta-blockers are one of the most important developments in cardiovascular medicine. Several randomized clinical trials evaluated the effectiveness and reliability of beta-blockers in different clinical conditions. Systemic hypertension, supraventricular and ventricular arrhythmias, chronic coronary syndromes, acute coronary syndromes and heart failure are the main indications for beta-blocker therapy. This article provides an assessment of the beta-blockers in the treatment of cardiovascular events and the role of nebivolol focused on the primary cardiovascular prevention.

Nebivolol is a third generation β1 selective beta-blocker with vasodilatory properties which is approved for the treatment of hypertension and heart failure. The vasodilatory effect is nitric-oxide mediated and activated via β3-agonism. Nebivolol has the highest β1-receptor affinity among β-blockers and it substantially improves endothelial dysfunction by its strong stimulatory effects on the activity of the endothelial NOS and via its antioxidative properties. Nebivolol reverses endothelial dysfunction in animal models of oxidative stress and human studies. In vitro, nebivolol has been shown to inhibit platelet aggregation and has antiproliferative effects.

Despite a long history of using in clinical setting and important treatment option by previous guidelines, recent guidelines has questioned the role of beta blockers in the treatment of hypertension, and were recomended to 2nd or 3rd line positions based on the outcome of recent trials and meta‐analyses. However, those studies and meta-analyses were achieved using first‐generation beta blockers and it should be remembered that beta blockers are heterogenous class as having different pharmacologic and physiologic profile. The question is whether third‐generation beta blockers with vasodilatory properties could offer advantages compared to previous beta blockers. This group has great potential for blood pressure lowering along with low metabolic side effect. Among all the beta blockers in clinical use today, nebivolol, which has the highest selectivity for beta-1 receptors with a different pharmacodynamic and kinetic profile, has great blood pressure lowering effect both monotherapy and in antihypertensive combination therapy. Nebivolol is not only safe and well tolerated, with exerts neutral or even benefical effects on metabolic parameters, it improves quality of life in patients with hypertension. In the light of those evidence nebivolol may be considered as first‐line treatment among the modern combination therapy.

Heart failure represents the final point of many cardiovascular disorders and has a prevalence of around 1–2% in the general population, rising to >10% in individuals aged ≥70 years. Advances in pharmacological and intracardiac device-based therapies have reduced mortality rates in patients with HF, but both short- and long-term mortality rates remain significant. Heart failure remains as ‘malignant’ as some of the common cancers in both men and women. Beta-blockers have been one of the mainstays of treatment with ensuing prognostic and symptomatic benefits, and different societies have thus included them in guidelines for management of heart failure. However, controversy exists as to the optimal selection of a particular beta-blocker for management of heart failure, as the available beta-blockers differ in their selectivity for adrenergic receptors and their effects on the peripheral circulation. Nebivolol is a third-generation, long-acting and highly selective β 1 adrenoreceptor antagonist that also exhibits nitric oxide-mediated vasodilatory effects via β 3 receptor agonism. Patients who develop a chronic heart failure usually need lifelong treatment, and finding the optimal personalized treatment for every patient is crucial. Management of heart failure should be based on the presence and magnitude of cardiovascular, noncardiovascular systems and comorbid conditions as well as on the individual characteristics of the drugs especially beta-blockers in question.

Nebivolol is a new generation beta-blocker that leads to vasodilation by virtue of nitric oxide (NO). As NO has an important role in normal endothelial function, nebivolol has a potential to have different effects compared to other beta-blockers, which stimulated many authors to conduct some researches focusing on these effects. Nebivolol has also taken attention in Turkey for its unique properties. In this paper, several studies that have been conducted in Turkey were selected and discussed focusing on its specific effects.