Measurement of blood pressure (BP) using a brachial cuff sphygmomanometer is universally accepted for the diagnosis of hypertension and prediction of cardiovascular diseases. However, brachial systolic BP does not represent actual systolic BP in the central arteries which encounter cardiac load directly. Due to wave amplification from central to peripheral arteries, a significant difference exists between the two. Central BP measurements also account for arterial stiffness, vessel branching and vascular mechanics, unlike brachial BP. Emerging data suggests that hypertension can be diagnosed more accurately by central pressure indices as compared to brachial BP. Various non-invasive techniques are now available to measure central BP indices owing to recent technological advances. Recently, it has been reported that different classes of anti-hypertensive drugs display differential effects on brachial and central BPs. Nebivolol is a cardio-selective beta-blocker which targets central systolic BP and reduces it significantly along with brachial BP. In this article, we will review the current literature to evaluate the role of central BP to diagnose hypertension in detail. We will also assess the clinical evidence to evaluate the role of nebivolol in the management of elevated central systolic BP. Central BP indices offer better estimation of BP in central arteries and should be considered in routine clinical practice. Nebivolol has shown significant reduction in aortic pressure and wave reflection and improvements in endothelial dysfunction and arterial stiffness in hypertensive patients.