Third-generation beta-adrenoceptor antagonists in the treatment of hypertension and heart failure.

Hypertensive treatment with beta-adrenoceptor antagonists (BAAs) has been successfully applied for four decades. These drugs have a beneficial effect on the health of the patients by both decreasing number of deaths and improving morbidity. Nevertheless, the BAAs differ in pharmacological properties. They have different lipophilicity, different adrenoceptor selectivity and/or varying additional abilities in cardiac tissue and periphery vasculature hereby exceeding their known receptor-blocking effects. Nebivolol shows nitric oxide-mediated vasodilating properties that improve arterial rigidity. Carvedilol has anti-oxidative and antiproliferative effects, which exert a beneficial effect on patients with chronic congestive heart failure (CHF). These findings suggest that the true potential of the third-generation BAAs and their value in the treatment of CHF, hypertension and following cardiovascular events has yet to be acknowledged. This MiniReview provides an overview of the third-generation BAAs and their effects on the vasculature of hypertensive patients and patients with CHF. Additionally, BAAs that potentially can be used in different patient groups are discussed.