Nebivolol 5 mg significantly reduced systolic blood pressure by a mean of 9.95 mmHg (95% CI -15.88 to -4.02) and diastolic blood pressure by 5.29 mmHg compared with placebo.
Meta-Analysis
Does nebivolol reduce blood pressure and improve safety/tolerability in hypertensive patients compared to placebo or other beta-blockers?
Nebivolol provides clinically meaningful reductions in blood pressure compared with placebo and offers advantages over other beta-blockers in blood pressure control and erectile function preservation.
Mean Difference: -9.95 (95% CI -15.88–-4.02)
Objective: This network meta-analysis (NMA) evaluated the efficacy and safety of nebivolol, a third-generation beta1-selective beta-blocker with nitric oxide–mediated vasodilatory properties, compared with other antihypertensive agents. Design and method: A systematic literature search of major databases, including PubMed, Embase, and Cochrane CENTRAL, was conducted through June 2025. Eligible studies included randomized controlled trials and non-randomized trials comparing nebivolol with placebo, other beta-blockers, or other first-line antihypertensive agents. Data extraction and risk-of-bias assessment were performed. A frequentist NMA was conducted using R software to compare nebivolol with multiple comparators. This report focuses on comparisons between nebivolol and placebo and other beta-blockers. Mean differences are reported. Results: A total of 108 studies were included in the systematic review and NMA. Nebivolol at a 5 mg dose significantly reduced systolic blood pressure (SBP) by -9.95 mmHg (95% confidence interval CI: -15.88 to -4.02) and diastolic blood pressure (DBP) by -5.29 mmHg (95% CI: -7.33 to -3.26) compared with placebo. In subgroup analyses of younger patients (<50 years), nebivolol also significantly reduced SBP by -8.50 mmHg (95% CI: -16.99 to -0.01) and DBP by -7.06 mmHg (95% CI: -8.77 to -5.35) versus placebo. When compared with other beta-blockers, nebivolol was associated with a higher likelihood of achieving blood pressure control (SBP <140 mmHg and DBP <90 mmHg) at the 2.5 mg dose (odds ratio OR = 4.14; 95% CI: 1.96–8.75) and at the 5 mg dose (OR = 1.15; 95% CI: 0.58–2.29). Nebivolol also significantly improved erectile function compared with metoprolol (+3.45 International Index of Erectile Function-5 points; 95% CI: 1.17–5.72). Safety analyses demonstrated no increase in adverse events at standard doses (5 mg: OR = 0.98; 95% CI: 0.77–1.26) compared with placebo Conclusions: This NMA demonstrates that nebivolol provides clinically meaningful reductions in both SBP and DBP compared with placebo and offers advantages over other beta-blockers in blood pressure control. Its maintained efficacy in younger patients and favorable erectile function profile support nebivolol as a valuable therapeutic option for hypertension management across a wide spectrum of patient populations.
Kreutz et al. (2026) conducted a meta-analysis in Hypertension. Nebivolol vs. Placebo or other beta-blockers was evaluated on Systolic blood pressure (SBP) reduction (MD -9.95 mmHg, 95% CI -15.88 to -4.02). Nebivolol 5 mg significantly reduced systolic blood pressure by a mean of 9.95 mmHg (95% CI -15.88 to -4.02) and diastolic blood pressure by 5.29 mmHg compared with placebo.