Nebivolol in chronic heart failure: current evidence and future perspectives

IMPORTANCE OF THE FIELD: Chronic activation of the sympathetic nervous system leads to deterioration of cardiovascular function in heart failure patients. In systolic heart failure, beta-blockers were proven to be effective in decreasing the number of deaths and improving morbidity. However, beta-blockers are a heterogeneous drug group, consisting of agents with different selectivity for adrenergic receptors and/or additional effects in heart or peripheral circulation. AREAS COVERED IN THE REVIEW: We describe the role of the sympathetic nervous system, beta-blockers and specifically nebivolol in chronic heart failure. WHAT THE READER WILL GAIN: Nebivolol is a third-generation beta-blocker, with high beta(1)/beta(2) selectivity. Moreover, it has important vasodilating properties, by stimulating the production of nitric oxide. Smaller studies have already shown beneficial effects of nebivolol treatment on surrogate end points in heart failure patients. The recently published SENIORS (Phase III) study in an elderly heart failure population demonstrated a decreased number of clinical events in patients treated with nebivolol. Importantly, this effect was observed in patients with both impaired and preserved left ventricular systolic function. TAKE HOME MESSAGE: Specific beta-blockers may have distinct effects in various subgroups of heart failure patients. So far, nebivolol is the only beta-blocker to have been shown effective in elderly heart failure patients, regardless of their left ventricular ejection fraction.