Abstract-The aim of this study was to investigate the effects of the vasodilating -blocker nebivolol and the cardioselective -blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (rϭ0.41; Pϭ0.001) and with central pulse pressure change (rϭ0.32; Pϭ0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-ofprinciple study provides evidence to suggest that -blockers with vasodilating properties may offer advantages over conventional -blockers in antihypertensive therapy; however, this remains to be tested in a larger trial. lood pressure (BP) varies throughout the arterial tree because of pulse wave amplification, a phenomenon of wave reflection and arterial stiffness. 1 Because of pulse wave amplification, reduction in brachial BP does not reflect changes in central BP, which may become a more important target in the treatment of hypertension. Recent data from the Strong Heart Study 2 confirm earlier results from smaller studies on high-risk patients 3,4 that central pulse pressure is superior to brachial pulse pressure in the prediction of further cardiovascular events. Moreover, several studies have demonstrated that brachial BP is not a good surrogate for the hemodynamic effects of drug therapies on central circulation. The recently published EX-PLOR Study 5 and the Conduit Artery Function Evaluation Study 6 clearly demonstrated that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers have a more pronounced effect on reducing central BP compared with the cardioselective -blocker (BB) atenolol. Different effects of BB on central BP can explain the findings of a recent meta-analysis published by Law et al, 7 which demonstrates a slight inferiority of BB in preventing stroke. The detrimental effect of BB on central BP has generated criticism regarding its use as first line therapy for essential hypertension. Dhakam et al 8 questioned the hypothesis that the inferiority of atenolol in reducing central BP is a class effect of BB. They demonstrated that the novel vasodilating BB nebivolol (NEB) reduces central BP si...