Nebivolol (bystolic), a novel Beta blocker for hypertension.

188 P&T® • April 2009 • Vol. 34 No. 4 INTRODUCTION Hypertension is an asymptomatic condition of persistently elevated blood pressure (BP) that affects approximately 50 million Americans and one billion people worldwide. It has been associated with other diseases and events such as myo cardial infarction (MI), heart failure, stroke, and kidney disease. Although hypertension the most common primary care diagnosis in the U.S., most patients are undertreated (fewer than 60% of patients receive any treatment), and only about 31% have BP that is adequately controlled. The management of hypertension involves lifestyle modifications, pharmacological treatment, or both. Weight reduction for overweight or obese patients, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, moderate consumption of alcohol, and physical activity are all essential to decreasing BP and enhancing the efficacy of pharmacotherapeutic regimens. Pharmacological treatment includes management with one or more agents belonging to the following drug classes: thiazide diuretics, beta blockers, calciumchannel blockers, angiotensin-converting enzyme (ACE)–inhibitors, and angiotensin receptor blockers (ARBs). approved by the FDA for the treatment of hypertension. The medication’s unique chemical structure is composed of a ra cemic mixture of d-nebivolol and l-nebivolol (Figure 1). Nebivolol exerts nitric oxide (NO)–mediated vaso dilation in addition to conventional beta-blocking effects.