Nebivolol, a third-generation beta-blocker, lowers blood pressure through an additional mechanism not shared by propranolol. This additional mechanism is:

• A Activation of alpha-1 receptors causing vasoconstriction
• B Calcium channel blockade in vascular smooth muscle
• C Potassium channel opening causing hyperpolarization
• D Endothelium-dependent vasodilation through increased nitric oxide (NO) bioavailability ✓

Explanation

Nebivolol is a highly selective beta-1 blocker that uniquely promotes endothelial nitric oxide synthase (eNOS) activation via the L-arginine–NO pathway, causing vasodilation — an effect mediated through beta-3 receptor stimulation on endothelial cells. This NO-mediated vasodilation lowers peripheral resistance in addition to the beta-1 blockade effect, resulting in better tolerability and possibly fewer metabolic adverse effects than older beta-blockers.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.