Hypertension, dyslipidemia, and insulin resistance in patients with diabetes mellitus or the cardiometabolic syndrome: benefits of vasodilating β-blockers

Prakash Deedwania, Prakash Deedwania

Abstract

Hypertension frequently coexists with diabetes and the cardiometabolic syndrome. β-Blockers have been a mainstay for controlling blood pressure for nearly 4 decades. However, β-blockers are perceived to cause glucose and lipid metabolism dysregulation, including hypoglycemia masking, reduced glycemic control, insulin resistance, and dyslipidemia. It should be noted, however, that β-blockers are diverse in their effects on glucose and lipid metabolism. Potential mechanisms that contribute to these metabolic effects include hemodynamic differences, anti-inflammatory and anti-oxidative pathways, and/or weight changes. Traditional β-blockers decrease cardiac output while peripheral vascular resistance increases or remains unchanged, which may result in glucose and lipid abnormalities. In contrast, vasodilating β-blockers reduce peripheral vascular resistance but have little effect on cardiac output. Vasodilating β-blockers may therefore result in less impact on insulin sensitivity and glycemic control, a reduced new-onset diabetes risk, and improved dyslipidemia compared with traditional β-blockers. Because of these effects, vasodilating β-blockers may represent a favorable option in the treatment of high-risk patients with hypertension.

© 2010 Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
 Relationship between insulin resistance, dyslipidemia, and hypertension. CVD indicates cardiovascular disease; LDL, low‐density lipoprotein; RAAS, renin‐angiotensin‐aldosterone system; SNS, sympathetic nervous system. Reproduced with permission from Stump and colleagues.
Figure 2
Figure 2
Comparison of extended‐release carvedilol (C) and extended‐release metoprolol (M) median change from baseline to treatment end for (A) triglycerides and (B) high‐density lipoprotein (HDL) in patient subgroups. BMI indicates body mass index; Met Syn, metabolic syndrome. Confidence interval overall is 97.5%. Reprinted from Fonarow and colleagues.50

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