Summary

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• Nebivolol (Bystolic) is indicated for the treatment of hypertension, with its effectiveness in lowering blood pressure comparable to other beta-blockers. It also has unique lipid-modifying effects among beta-blockers, significantly lowering low-density lipoprotein cholesterol and increasing high-density lipoprotein cholesterol.
• Six systematic reviews/meta-analyses provide a comprehensive analysis of nebivolol's safety and effectiveness compared to other drugs used for treating hypertension.
• The studies highlight that nebivolol requires dosage adjustment in different patient populations such as those with chronic kidney disease or obesity due to variations in metabolism between poor and extensive metabolizers, indicating the importance of personalized dosing.
• In cancer patients undergoing chemotherapy, nebivolol shows promise in attenuating chemotherapy-induced cardiotoxicity compared to other cardio-protective agents like spironolactone, enalapril, and statins. This suggests potential applications beyond hypertension management, particularly for subgroups at elevated cardiovascular risk due to chemotherapy.
• Compared with second-generation beta-blockers, nebivolol demonstrates superior tolerability along with a lower risk of adverse events, emphasizing its favorable safety profile especially amongst hypertensive patients.
• Despite mechanisms suggesting potential benefits on endothelial function associated with its vasodilatory properties attributed to nitric oxide release, it does not demonstrate superior efficacy over other antihypertensive classes or beta-blockers in terms of improving endothelial dysfunction.