TY - JOUR
T1 - Beta-blocking agents in patients with insulin resistance
T2 - Effects of vasodilating beta-blockers
AU - Jacob, Stephan
AU - Balletshofer, Bernd
AU - Henriksen, Erik J.
AU - Volk, Annette
AU - Mehnert, Birgit
AU - Löblein, Klaus
AU - Häring, Hans Ulrich
AU - Rett, Kristian
PY - 1999
Y1 - 1999
N2 - Essential hypertension is - at least in many subjects - associated with a decrease in insulin sensitivity, while glycaemic control is (still) normal. It seems that in hypertensive patients, two major functions of insulin are impaired: there is insulin resistance of peripheral glucose uptake (primarily skeletal muscle) and insulin resistance of insulin-stimulated vasodilation. In view of some retrospective data and meta-analyses, which showed a less than expected reduction in coronary events (coronary paradox), the metabolic side effects of the antihypertensive treatment have received more attention. Many groups have shown that conventional antihypertensive treatment, both with beta-blockers and/or diuretics, decreases insulin sensitivity by various mechanisms. While low-dose diuretics seem to be free of these metabolic effects, there is no evidence for this in the β-adrenergic blockers. However, recent metabolic studies evaluated the effects of vasodilating beta- blockers, such as dilevalol, carvedilol and celiprolol, on insulin sensitivity and the atherogenic risk factors. None of them decreased insulin sensitivity, as has been described for the beta-blockers with and without β1 selectivity. This supports the idea that peripheral vascular resistance and peripheral blood flow play a central role in mediating the metabolic side effects of the beta-blocking agents, as the vasodilating action (either via β2 stimulation or α1-blockade) seems to more than offset the detrimental effects of the blockade of β (or β1) receptors. Further studies are needed to elucidate the relevance of the radical scavenging properties of these agents and their connection to their metabolic effects. Therefore, the beneficial characteristics of these newer beta-adrenoreceptor blockers suggest that the vasodilating beta-blocking agents could be advantageous for hypertensive patients with insulin resistance or type 2 diabetes.
AB - Essential hypertension is - at least in many subjects - associated with a decrease in insulin sensitivity, while glycaemic control is (still) normal. It seems that in hypertensive patients, two major functions of insulin are impaired: there is insulin resistance of peripheral glucose uptake (primarily skeletal muscle) and insulin resistance of insulin-stimulated vasodilation. In view of some retrospective data and meta-analyses, which showed a less than expected reduction in coronary events (coronary paradox), the metabolic side effects of the antihypertensive treatment have received more attention. Many groups have shown that conventional antihypertensive treatment, both with beta-blockers and/or diuretics, decreases insulin sensitivity by various mechanisms. While low-dose diuretics seem to be free of these metabolic effects, there is no evidence for this in the β-adrenergic blockers. However, recent metabolic studies evaluated the effects of vasodilating beta- blockers, such as dilevalol, carvedilol and celiprolol, on insulin sensitivity and the atherogenic risk factors. None of them decreased insulin sensitivity, as has been described for the beta-blockers with and without β1 selectivity. This supports the idea that peripheral vascular resistance and peripheral blood flow play a central role in mediating the metabolic side effects of the beta-blocking agents, as the vasodilating action (either via β2 stimulation or α1-blockade) seems to more than offset the detrimental effects of the blockade of β (or β1) receptors. Further studies are needed to elucidate the relevance of the radical scavenging properties of these agents and their connection to their metabolic effects. Therefore, the beneficial characteristics of these newer beta-adrenoreceptor blockers suggest that the vasodilating beta-blocking agents could be advantageous for hypertensive patients with insulin resistance or type 2 diabetes.
KW - Antihypertensive treatment
KW - Atherogenic risk factors
KW - Betablocking agents
KW - Insulin sensitivity
KW - Vasodilating beta-blocker
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U2 - 10.1080/080370599439463
DO - 10.1080/080370599439463
M3 - Review article
C2 - 10803485
AN - SCOPUS:0033501503
SN - 0803-7051
VL - 8
SP - 261
EP - 268
JO - Blood Pressure
JF - Blood Pressure
IS - 5-6
ER -