Reducing the risk for coronary events and stroke in hypertensive patients: Comments on present evidence

Wikstrand, John

doi:10.1002/clc.4960140706

Cited by 2 publications

(2 citation statements)

References 72 publications

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“…However, insulin release and glucose mobilization from the liver are predominantly mediated by β 2 receptors and this side‐effect may be reduced or abolished with β 1 selective agents. The metabolic impact of selective antagonists is demonstrably less than that seen with thiazide diuretics (62, 63).…”

Section: Glucose Tolerancementioning

confidence: 99%

“…In contrast to thiazide diuretics, β 1 selective antagonists were shown to significantly reduce serum total cholesterol concentration in the MAPHY study (41). Alterations in the size, charge and density of low‐density lipoproteins, proteoglycan binding and endothelial damage help explain the reduced accumulation of cholesterol within the intima seen with β 1 selective antagonists (62, 63).…”

Section: Impact On Plasma Lipidsmentioning

confidence: 99%

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The cardioprotective role of beta-blockers in patients with diabetes mellitus

2002

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This paper reviews the role of b-blockers in the prevention of cardiovascular morbidity and mortality in patients with diabetes mellitus. There is good evidence from randomized controlled trials that b-blockers, in particular the lipophilic agents, substantially reduce cardiovascular mortality and morbidity. However, hitherto b-blockers have been underused in diabetic patients, perhaps because of perceived risks of b-blocker therapy. Reappraisal of the evidence suggests that the traditional reluctance to use b-blockers in this group is based on fears of adverse effects that are largely unfounded.

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Section: Glucose Tolerancementioning

confidence: 99%

Section: Impact On Plasma Lipidsmentioning

confidence: 99%

The cardioprotective role of beta-blockers in patients with diabetes mellitus

2002

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Beta-Adrenergic Blocking Drugs in the Treatment of Hypertension

2001

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The reduction in blood pressure seen with the use of beta-blocking drugs was an unexpected finding. Initially there was resistance to their use as the reduction of cardiac output and increase in peripheral resistance from beta-blockade was considered an undesirable pharmacological action for a drug in the treatment of hypertension. However, beta-blockers have now become established in the treatment of hypertension and have been recommended as a first line choice in various guidelines, although their exact mode of action remains a matter for debate. In broad terms beta-blocking drugs are at least of similar efficacy to the other major classes of antihypertensive drugs. They may be usefully combined with other anti-hypertensives, as is often required. There is some evidence that the beta-1 selective agents are more efficacious than the non-selective beta-blockers. Notwithstanding some observations to the contrary beta-blockers are often effective antihypertensive agents in the elderly and in black patients; the combination of being elderly and black, however, appears to result in a reduced fall in blood pressure. If they are given early in pregnancy they lead to a low birth weight. Co-existant disease may influence the choice of a beta-blocker to treat hypertension. Beta-blockers are valuable agents in ischaemic heart disease, notably the control of chronic angina pectoris and to improve prognosis post-myocardial infarction. While initial dose titration has to be extremely careful, heart failure is now a strong indication for the use of a beta-blocker, as prognosis is much improved. Diabetes should no longer be regarded as a contra-indication to the use of a beta-1 selective agent. Recent work confirms that beta-blockers should be given to patients undergoing surgery who have a high cardiac risk. Outcome studies suggest overall that in younger patients beta-blockers reduce the incidence of strokes and myocardial infarction. There is no convincing evidence of a difference between the ACE inhibitor captopril and the combination of diuretic and a beta-blocker. In high risk patients, i.e. those with diabetes, no difference was seen between captopril and atenolol. Diuretics may result in better outcome measurements in the elderly compared to beta-blockade but in combination, "conventional treatment" is as effective in terms of total mortality, strokes and myocardial infarction as ACE inhibitors or calcium antagonists. Co-existant asthma remains an important contraindication to beta-blockade, but not chronic obstructive airways disease where a beta-blocker should be used with caution if it is indicated, e.g. post-infarction. Quality of life measurements, at least with beta-1 selective agents compare favourably with other anti-hypertensive drugs. Beta-blockers, without partial agonist activity, should not be stopped abruptly, particularly in patients with, or at high risk of, co-existant ischaemic disease because of the danger of post-beta-blockade cardiac sympathetic hypersensitivity; alternatively bed rest should be ins...

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Reducing the risk for coronary events and stroke in hypertensive patients: Comments on present evidence

Cited by 2 publications

References 72 publications

The cardioprotective role of beta-blockers in patients with diabetes mellitus

The cardioprotective role of beta-blockers in patients with diabetes mellitus

Beta-Adrenergic Blocking Drugs in the Treatment of Hypertension

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