<b>The effect of metoprolol treatment on insulin sensitivity and diurnal plasma hormone levels in hypertensive subjects</b>

Guðbjörnsdóttir, Soffia; Fowelin, J.; Elam, Marshall B.; Attvall, Stig; Bengtsson, Bengt‐Åke; Mårin, Per; Lönnroth, Peter

doi:10.1046/j.1365-2362.1997.670617.x

Cited by 9 publications

(11 citation statements)

References 46 publications

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“…12,32 The GEMINI and COMET studies found that metoprolol adversely affected glucose metabolism, but carvedilol had neutral metabolic effects. 8,9 A recent review showed that carvedilol did not adversely affect plasma lipids compared to β1-selective agents.…”

Section: Discussionmentioning

confidence: 99%

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β-AR Polymorphisms and Glycemic and Lipid Parameters in Hypertensive Individuals Receiving Carvedilol or Metoprolol

Vardeny¹,

Nicholas²,

Andrei³

et al. 2012

Am J Hypertens

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Background β-blocker therapy and β-adrenergic receptor (β-AR) polymorphisms are associated with increases in glucose and lipid levels. We investigated associations of common β1 and β2- AR single nucleotide polymorphisms (SNPs) with metabolic and lipid variables, and examined interactions with β-blocker treatment assignment to affect these parameters. Methods This was a Post hoc analysis of a double-blinded clinical trial of non-diabetic, hypertensive individuals that were randomized to receive carvedilol or metoprolol succinate. Fasting glucose, insulin, and lipid levels were measured at baseline, 3, and after 6 months. Genotypes for β1-AR SNPs Ser49Gly & Gly389Arg and β2-AR Arg16Gly & Gln27Glu were determined. Multivariable mixed models were used to examine associations between β-AR polymorphisms, metabolic parameters, and SNP interactions with β-blocker therapy (pinteraction). Results The 322 subjects were mean (standard deviation) 51.5 (11.2) years old. After 6 months, insulin levels increased by 35.6% on metoprolol but decreased by 9.9% on carvedilol (p=0.015). In univariate models, the Gln27Gln genotype had higher overall insulin levels with β-blockade compared to the Glu27Glu genotype (p=0.006). Both Arg16Gly (p=0.012) and Gln27Glu (p=0.037) SNPs were associated with triglycerides levels. An interaction between the Arg16Gly SNP and treatment was identified (pint=0.048). Conclusions These data suggest that insulin and triglycerides may be influenced by β2-AR polymorphisms in patients taking β–blockers.

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Section: Discussionmentioning

confidence: 99%

“…12-14 Stimulation of the β2-AR also mediates hepatic glycogenolysis and lipolysis in adipose tissues. 15 Selective (β1) blockade by conventional βblockers, such as metoprolol, leads to unopposed α1-mediated vasoconstriction, thereby reducing blood flow to muscles and glucose uptake in peripheral tissues.…”

Section: Introductionmentioning

confidence: 99%

β-AR Polymorphisms and Glycemic and Lipid Parameters in Hypertensive Individuals Receiving Carvedilol or Metoprolol

Vardeny¹,

Nicholas²,

Andrei³

et al. 2012

Am J Hypertens

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“…18 Beta blockers also interfere with β2 mediated pancreatic insulin release. 3,19,20 Additionally, reduced insulin release and blockade of hepatic β2 adrenergic receptors elevates glucose production following meals. 4 Beta-blockers have also been shown to increase weight, 21 which is associated with development of diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Beta-blockers may negatively affect glucose homeostasis through increased hepatic glucose production, blockade of insulin release, and may worsen insulin resistance through reduced peripheral glucose ulitization. 3,4 The effect of angiotensin converting enzyme (ACE) inhibitors on diabetes risk has been more varied. Post-hoc analyses in large trials originally suggested that ACE inhibition might delay or prevent the onset of DM, 2,5,6 while the DREAM trial did not show a benefit on frank development of diabetes, although did show some improvement in glycemic control with ACE inhibitors.…”

Section: Introductionmentioning

confidence: 99%

Opposing Effects of β Blockers and Angiotensin-Converting Enzyme Inhibitors on Development of New-Onset Diabetes Mellitus in Patients With Stable Coronary Artery Disease

Vardeny

Uno

Braunwald

et al. 2011

The American Journal of Cardiology

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We utilized data from patients with stable coronary artery disease (CAD) to assess the risk of new onset diabetes (NOD) with beta-blockers, and to determine whether angiotensin converting enzyme (ACE) inhibition would modify this risk. The Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) trial randomized 8290 patients with stable CAD to trandolapril or placebo. The presence of NOD was assessed at each study visit over a median follow-up time of 4.8 years. We examined the risk of NOD associated with beta-blockers use with Cox regression models, adjusting for 25 baseline covariates, and tested whether this risk was modified by randomization to the ACE inhibitor. Of 6910 patients without diabetes mellitus at enrollment (1179 females/5731 males, mean age 64 ± 8 years), 4147 (60%) were taking beta blockers, and 733 (8.8%) developed NOD. We observed a significant interaction between beta-blocker use and randomization to ACE inhibitor with respect to new onset diabetes (p = 0.028). Participants taking beta-blockers assigned to the placebo group (N=2090) were at increased risk for NOD adjusting for baseline covariates (HR 1.63, 95% confidence interval 1.29, 2.05, p<0.001, while this risk was attenuated in those assigned to trandolapril (N=2057) (HR 1.11, 95% confidence interval 0.87, 1.42; p=0.39). Beta blocker use was associated with increased risk for NOD in patients with stable CAD, and this risk was reduced in patients treated concurrently with an ACE inhibitor. In conclusion, these data suggest that ACE inhibition may attenuate the risk for glucose abnormalities observed in patients taking beta blockers.

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“…Adverse effects of blockade of ß 2 ‐receptors on glucose metabolism have been recognized and repeatedly described [31, 32]. In contrast to unselective betablockers, ß 1 ‐selective blockers appear to be without relevant influence on glucose metabolism [32–35]. However, in some studies adverse effects of ß 1 ‐selective betablockers have been described [36].…”

Section: Do Betablockers Have Adverse Effect On Blood Glucose Metabolmentioning

confidence: 99%

Betablocker treatment in diabetes mellitus

Sawicki

Siebenhofer

2001

Journal of Internal Medicine

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Abstract. Sawicki PT, Siebenhofer A (St Franziskus Hospital in Cologne, Germany; Karl-Franzens University in Graz, Austria). Betablocker treatment in diabetes mellitus (Review). J Intern Med 2001; 250: 11±17.Objectives. Betablockers have been convincingly shown to reduce total and cardiovascular morbidity and mortality of hypertensive diabetic patients. In diabetic patients, after myocardial infarction, these agents confer a twice as high protective effect when compared to non-diabetic patients. However, most paradoxically, betablocking agents are used less frequently in diabetes. Control of hypertension is insuf®-cient in most of the diabetic patients, probably because a combination of antihypertensive agents including betablockers is frequently needed to suf®ciently control blood pressure but is not used in these patients. The fear of betablocker-associated side effects in diabetes may be partly responsible for the frequent antihypertensive mono-therapy and the resulting poor quality of blood pressure control among diabetic patients. Design.We have performed an analysis of the literature to assess whether possible adverse metabolic effects, a higher risk of hypoglycaemia or less nephroprotective effects of û 1 -selective betablocking agents could justify the reticence in prescribing these antihypertensive agents to diabetic patients. Results. A thorough review of the literature does not indicate that û 1 -selective betablocking agents have important adverse effects on glucose metabolism, prolong hypoglycaemia or mask hypoglycaemic symptoms. In diabetic nephropathy, betablockers are as nephroprotective as angiotensin converting enzyme inhibitors. Conclusions. The unnecessary less frequent prescription of û 1 -selective betablockers in diabetes mellitus may contribute to the higher cardiovascular mortality among these patients.

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The effect of metoprolol treatment on insulin sensitivity and diurnal plasma hormone levels in hypertensive subjects

Cited by 9 publications

References 46 publications

β-AR Polymorphisms and Glycemic and Lipid Parameters in Hypertensive Individuals Receiving Carvedilol or Metoprolol

β-AR Polymorphisms and Glycemic and Lipid Parameters in Hypertensive Individuals Receiving Carvedilol or Metoprolol

Opposing Effects of β Blockers and Angiotensin-Converting Enzyme Inhibitors on Development of New-Onset Diabetes Mellitus in Patients With Stable Coronary Artery Disease

Betablocker treatment in diabetes mellitus

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