A 59-year-old man presented to the cardiology outpatient clinic with persistently elevated blood pressure despite good adherence to antihypertensive therapy. He had an 8-year history of hypertension, anterior myocardial infarction treated with percutaneous coronary intervention (PCI) 3 years earlier, dyslipidaemia, and obesity (body mass index 30.4 kg/m²). He denied angina, dyspnoea, dizziness, or palpitations but reported mild exertional fatigue. He was a non-smoker and consumed alcohol occasionally. Office blood pressure was 152/92 mmHg, confirmed by home blood pressure monitoring (HBPM) (average 148/90 mmHg). Resting heart rate was 84 beats/min. Electrocardiography showed normal sinus rhythm without new ischaemic changes, while echocardiography demonstrated preserved left ventricular ejection fraction (LVEF) of 58%. Renal function, serum electrolytes, fasting glucose, and thyroid function were within normal limits. His medications included telmisartan 80 mg, amlodipine 10 mg, atorvastatin 40 mg, and aspirin 75 mg once daily. Despite optimal doses of an angiotensin receptor blocker (ARB) and calcium channel blocker (CCB), his blood pressure remained above target and his resting heart rate was relatively elevated. Given his history of coronary artery disease (CAD) following myocardial infarction, initiation of the β₁-selective vasodilating β-blocker nebivolol was considered to improve blood pressure and heart rate control while providing secondary cardiovascular benefit. Current hypertension guidelines recommend β-blockers in patients with hypertension when compelling cardiovascular indications, such as previous myocardial infarction or chronic coronary syndrome, are present.