CRD Summary: The authors concluded that nebivolol 5 mg may have benefits in hypertensive patients compared to existing antihypertensives and may have a role in the first-line treatment of hypertension. Evidence appeared to support the authors’ conclusions, but the limited search and inadequate validity assessment made it difficult to comment on the strength of the evidence underpinning the authors’ conclusions.

[The included studies compared 5 mg/day nebivolol with the following: placebo; beta-blockers (atenolol 50 mg or 100 mg, metoprolol 100 bid or bisoprolol 5 mg); CCA (nifedipine SR 20 mg or amlodipine 5 mg to 10 mg); ACEI (enalapril 10 mg or lisinopril 20 mg); and ARA (losartan 50 mg). ]

CRD Commentary: The review question and inclusion criteria were stated clearly. Limiting the search to English language reports identified in one database plus references may have resulted in the omission of other relevant studies and raised the potential for publication and language bias. Appropriate methods were used to minimise reviewer error and bias during the selection of studies, but it was not clear if similar methods were used for the extraction of data. Apart from blinding, study validity was not assessed and so results from these studies and any synthesis may not be reliable. Appropriate methods were used for the meta-analyses. Results of the reported assessment of heterogeneity were not reported, but overlapping 95% CIs in forest plots suggested homogeneity. A non-definitive conclusion appeared appropriate in view of the short duration of treatments evaluated. Evidence appeared to support the authors’ conclusions, but the limited search and inadequate validity assessment made it difficult to comment on the strength of the evidence underpinning the authors’ conclusions.