Diastolic heart failure in hypertension: possible preventive benefits of nebivolol beyond lowering blood pressure.

Arterial hypertension is one of the most prevalent cardiovascular diseases and one of the most important causes of heart failure with low or preserved ejection fraction. Although many drugs are highly effective in lowering blood pressure, the optimal treatment for preventing progression to heart failure is still uncertain. Beta-blockers, a class of drugs with well-established indications and benefits for both hypertension and heart failure seem to show different pharmacological properties with different consequences on the cardiovascular hemodynamic. The third class beta-blocker nebivolol, by its particular mechanism of vasodilatation mediated by nitric oxide release, has been proven to provide substantial benefits beyond the effect of blood pressure lowering, such as reversal of endothelial dysfunction, improvement of ventricular-arterial coupling, improvement of coronary flow reserve and an overall improvement of the diastolic function which is independent of the changes in ventricular geometry. Thus, nebivolol seems to be superior to other "classical" beta-blockers for the reversal of subclinical left ventricular dysfunction in hypertensive patients, before the onset of overt heart failure. This could be an important fact to take into consideration especially for the early stages of heart failure with preserved ejection fraction for which the optimal management is not established yet.