OBJECTIVE: beta-blockers (BBs) with different pharmacological properties may have heterogeneous effects on sympathetic nervous activity (SNA) and central aortic pressure (CAP), which are independent cardiovascular factors for hypertension. Hence, we analyzed the effects of bisoprolol and atenolol on SNA and CAP in hypertensive patients. METHODS: This was a prospective, randomized, controlled study in 109 never-treated hypertensive subjects randomized to bisoprolol (5 mg) or atenolol (50 mg) for 4-8 weeks. SNA, baroreflex sensitivity (BRS) and heart rate (HR) variability (HRV) were measured using power spectral analysis using a Finometer. CAP and related parameters were determined using the SphygmoCor device (pulse wave analysis). RESULTS: Both drugs were similarly effective in reducing brachial BP. However, central systolic BP (-14+/-10 mm Hg vs -6+/-9 mm Hg; P<0.001) and aortic pulse pressure (-3+/-10 mm Hg vs +3+/-8 mm Hg; P<0.001) decreased more significantly with bisoprolol than with atenolol. The augmentation index at a HR of 75 bpm (AIxatHR75) was significantly decreased (29%+/-11% to 25%+/-12%; P = 0.026) in the bisoprolol group only. Furthermore, the change in BRS in the bisoprolol group (3.99+/-4.19 ms/mmHg) was higher than in the atenolol group (2.66+/-3.78 ms/mmHg), although not statistically significant (P>0.05). BRS was stable when RHR was controlled (RHR</=65 bpm), and the two treatments had similar effects on the low frequency/high frequency (HF) ratio and on HF. CONCLUSION: BBs seem to have different effects on arterial distensibility and compliance in hypertensive subjects. Compared with atenolol, bisoprolol may have a better effect on CAP. TRIAL REGISTRATION: ClinicalTrials.gov NCT01762436.