Selectivity of beta-blockers, cardiovascular and all-cause mortality in people with hypoglycaemia: An observational study

Abstract

Background and Aims:The association of beta-blockers and their selectivity with mortality and cardiovascular events in patients with and without hypoglycaemia is unknown. Methods and Results:Insulin-treated patients with diabetes were identified within the UK CPRD database. All-cause deaths, cardiovascular events, and hypoglycaemic episodes were captured to assess the interaction between beta-blocker therapy and selectivity with hypoglycaemia. 13682 patients, of which 2036 (14.9%) with at least one hypoglycaemic episode, were included; 3148 deaths and 1235 cardiovascular events were recorded during a median of 2.3 and 4.7 years in patients with and without incident hypoglycaemia, respectively. Treatment with any beta-blocker was not associated with risk of death in both patients with and without hypoglycaemia, without significant interaction. Compared to no therapy, non-selective beta-blockers were associated with higher risk of death in patients without hypoglycaemia (hazard ratio (HR) 2.93 [1.26-6.83] in the fully adjusted model) but not in those with hypoglycaemia; interactions was not significant. For beta1-selective betablockers, there was no association with mortality in both patients with and without hypoglycaemia, without significant interaction. After missing data imputation, results were consistent for nonselective beta-blockers (HR in patients without hypoglycaemia 1.59 [1.22-2.08]) while indicated a reduced risk of death for beta1-selective beta-blockers in patients with hypoglycaemia ). Due to few cardiovascular events, complete-case analysis compared only any vs no betablocker therapy and indicated no associations with therapy or interaction by hypoglycaemia. Conclusion:In patients with hypoglycaemic episodes, treatment with beta1-selective beta-blockers may potentially reduce the risk of death. These explorative findings and the potential role of confounding by indication need to be evaluated in other studies.

Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients

“…Nevertheless, BBs appeared to be protective of the increase in all-cause and cardiovascular death observed with intensive glycemic control in the ACCORD trial [15]; however BB type and insulin use was not analyzed separately in any of these studies. The present findings are consistent with a recent observational study of outpatients, which found that SBB but not nonselective BB were associated with a possible reduction in mortality in patients with episodes of hypoglycemia [46]. In another study of older nursing home patients discharged after myocardial infarction, there was no difference in mortality between patients prescribed carvedilol and those prescribed metoprolol [28].…”

Impact of beta-blockers on mortality and cardiovascular disease outcomes in patients with obstructive sleep apnoea: a population-based cohort study in target trial emulation framework

“…There have been previous observations on an increase in the risks for cardiovascular events and mortality in beta-blocker-treated than non-beta blocker-treated patients with diabetes mellitus. 25 , 26 , 27 Similarly, beta-blocker was not associated with improved cardiovascular or mortality outcomes in patients without recent MI. 28 , 29 , 30 However, due to the difference in patient profiles and the unique pathophysiology of OSA, our findings should be interpreted within the context of patients with OSA and caution against their generalisation to other populations.…”