Nebivolol Reduces Stroke Volume Less Than Propranolol
Propranolol is more effective at reducing stroke volume than nebivolol, due to nebivolol's unique nitric oxide-mediated vasodilation that preserves or even increases stroke volume despite reducing heart rate. 1, 2, 3
Hemodynamic Mechanisms
Nebivolol's Unique Profile
- Nebivolol increases stroke volume through its dual mechanism: selective β1-blockade combined with nitric oxide (NO)-mediated vasodilation that reduces peripheral vascular resistance while preserving cardiac output. 1, 2
- The blood pressure lowering effect is achieved through reduced peripheral resistance rather than decreased cardiac output, with stroke volume actually increasing to compensate for heart rate reduction. 2, 3
- In patients with heart failure, nebivolol significantly increased stroke volume while maintaining cardiac output, unlike traditional β-blockers. 4
- The NO-potentiating effect causes peripheral vasodilation that counteracts the typical stroke volume reduction seen with conventional β-blockers. 5
Propranolol's Traditional β-Blocker Effect
- Propranolol, as a non-selective traditional β-blocker, reduces stroke volume through standard negative inotropic effects without the compensatory vasodilatory mechanisms present in nebivolol. 6
- Traditional β-blockers like propranolol reduce central pulse pressure and stroke volume as part of their mechanism to lower blood pressure. 6
Clinical Implications
When Stroke Volume Reduction Is Desired
- For conditions requiring stroke volume reduction (such as acute aortic dissection or hypertrophic cardiomyopathy), propranolol would be more appropriate than nebivolol. 6
- In acute aortic disease, guidelines recommend traditional β-blockers like metoprolol or esmolol specifically for their ability to reduce both heart rate and stroke volume. 6
When Stroke Volume Preservation Is Preferred
- Nebivolol is advantageous in heart failure where maintaining cardiac output is critical—it reduces heart rate and blood pressure without compromising left ventricular function or stroke volume. 7, 4
- The American College of Cardiology and European Society of Cardiology recognize nebivolol's efficacy in heart failure with reduced ejection fraction, where stroke volume preservation is beneficial. 7
Important Caveats
- The vasodilating β-blockers (nebivolol, carvedilol, celiprolol) reduce central pulse pressure and aortic stiffness better than traditional β-blockers like atenolol or metoprolol, but this comes with stroke volume preservation rather than reduction. 6
- Nebivolol does not significantly decrease left ventricular function and may increase stroke volume even during exertion, fundamentally distinguishing it from propranolol. 3, 4