Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients.

Pollare, Thomas; Lithell, Hans; Selinus, Ingemar; Berne, Christian

doi:10.1136/bmj.298.6681.1152

Cited by 331 publications

(186 citation statements)

References 43 publications

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“…On the other hand, studies of the effect of b-blocking agents on insulin sensitivity have yielded conflicting results. A significant reduction in glucose tolerance by metoprolol and atenolol [8] and by propanolol [9] has been reported in hypertensive patients, but this effect of b-blocking agents was not observed in two other studies [10,11]. Furthermore, studies in healthy normotensive subjects report no significant effect on insulin sensitivity after treatment with b-adrenergic blocking agents [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, it is of major concern that previous investigations have demonstrated that antihypertensive treatment with beta (b)-blocking agents may decrease insulin sensitivity [8] and, consequently, could reduce the benefit of lowering the blood pressure with regard to risk of coronary heart disease. On the other hand, studies of the effect of b-blocking agents on insulin sensitivity have yielded conflicting results.…”

Section: Introductionmentioning

confidence: 99%

“…Several underlying mechanisms for a putative reduction of insulin sensitivity during treatment with b-blocking drugs have been suggested as these agents may induce haemodynamic changes [15] and also interfere with muscle glucose oxidation [16] as well as with insulin metabolism [8]. An effect of b-blockade on secretion of growth hormone (GH) [17] and/or an effect on the clearance of catecholamines [18] may also be important [19,20].…”

Section: Introductionmentioning

confidence: 99%

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

Guðbjörnsdóttir¹,

Fowelin²,

Elam³

et al. 1997

Eur J Clin Investigation

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Abstract.To evaluate the effect of metoprolol on insulin sensitivity and diurnal plasma hormone levels, seven mildly hypertensive subjects were investigated (four men and three women, age 52 Ϯ 8, body mass index 25 . 4 Ϯ 1 . 9, mean Ϯ SD). The study had a placebo-controlled, double-blind, crossover design with 6 weeks' metoprolol treatment (100 mg b.i.d) vs. placebo. At the end of each treatment period 24-h blood samples were collected continuously for diurnal analysis of hormone levels and a hyperinsulinaemic euglycaemic clamp combined with [3-3 H]-D-glucose infusion was performed. Insulin sensitivity was evaluated by means of three different methods: diurnal plasma insulin and glucose levels; glucose consumption; and insulin sensitivity index during euglycaemic clamp conditions. Fasting blood glucose and insulin concentrations as well as mean plasma diurnal levels of insulin, growth hormone, testosterone and cortisol were similar after placebo and metoprolol treatment, whereas noradrenaline and adrenaline levels were significantly increased after metoprolol. During the clamp, plasma insulin was significantly higher after metoprolol treatment than after placebo treatment (56 Ϯ 3 vs. 64 Ϯ 2 mU L -1 , P < 0 . 05). Consequently, the insulin sensitivity index [glucose infusion rate (GIR)/ plasma insulin] was lower after metoprolol treatment (16 . 1 Ϯ 2 . 6 vs. 10 . 2 Ϯ 1 . 2, P < 0 . 05), although GIR was not significantly changed. We suggest that the insulin sensitivity index may not accurately reflect the insulin effect as the plasma level of insulin was significantly increased during insulin infusion but not at 24 h, possibly because of alteration of distribution and/or degradation rate of exogenous insulin. Thus, the likelihood of metoprolol inducing insulin resistance in hypertensive subjects may be less than previously proposed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Guðbjörnsdóttir¹,

Fowelin²,

Elam³

et al. 1997

Eur J Clin Investigation

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“…This can result in decrease of glucose tolerance, increase in triglyceride levels and decrease in highdensity lipoprotein (HDL) levels, as well as weight gain. 5,6 Recently, the clinical relevance of these negative metabolic effects has been documented as an increased risk of diabetes mellitus, 7 which is also true for chlorthalidone. 8 Alternatively, the positive effects on glucose and lipid metabolism of centrally acting drugs -agonists of imidazoline receptors were shown.…”

Section: Introductionmentioning

confidence: 99%

“…9 K b-Blockers can worsen lipid profile and insulin resistance. 5,6 K Rilmenidine administration can lead to decrease in left ventricular hypertrophy. 44,47 What this study adds K Rilmenidine decreases hyperinsulinaemia, hyperglycaemia, and hypertriglyceridaemia in patients with metabolic syndrome.…”

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confidence: 99%

How can we block sympathetic overactivity? Effects of rilmenidine and atenolol in overweight hypertensive patients

et al. 2006

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The aim of the present study was to evaluate effects of long-term treatment with rilmenidine compared with atenolol on lipid and glucose metabolism and cardiovascular remodelling in hypertension. In total, 37 patients with hypertension were randomised to rilmenidine 1-2 mg/day or atenolol 50-100 mg/day for 26 weeks. Standard oral glucose tolerance test with a parallel measurement of insulin and glucose levels was performed. The 'areas under the curve' (AUC) for insulin and glucose were calculated. Plasma lipids, left ventricular mass index (LVMI), and intima-media thickness (IMT) were measured. Brachial artery diameter during reactive hyperaemia was used to test endotheliumdependent vasodilatation (EDVD). Blood pressure reduction was equally achieved in both treatment arms. The fasting glucose level increased in the atenolol group from 4.870.6 to 5.270.7 mmol/l (Po0.01). The AUC of glucose in rilmenidine group decreased from 860793 to 737766 mmol/min/l (Po0.05), and in the atenolol group it increased from 937786 to 989788 mmol/min/l (Po0.05). Rilmenidine showed a positive effect on lipid levels, whereas in the atenolol group a significant decrease of high-density lipoprotein cholesterol was observed. Left ventricular mass index decreased with rilmenidine by 9.6% and by 6.9% with atenolol (Po0.05). Intima-media thickness significantly decreased in the rilmenidine group. Endothelium-dependent vasodilatation slightly increased on in the rilmenidine group, while on in the atenolol group it remained unchanged. Our data suggest that in hypertensive patients central inhibition of sympathetic drive can produce favourable effects on glucose and lipid metabolism compared with standard b-blockade with a similar antihypertensive efficacy. Rilmenidine also provides beneficial effects on cardiovascular remodelling and altered endothelial function in hypertension.

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Blood Pressure Reduction and the Risk of Myocardial Infarction

Staessen¹

1990

JAMA

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Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients.

Cited by 331 publications

References 43 publications

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

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

How can we block sympathetic overactivity? Effects of rilmenidine and atenolol in overweight hypertensive patients

Blood Pressure Reduction and the Risk of Myocardial Infarction

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