The American Journal of Medicine
Volume 123, Issue 7, Supplement , Pages S21-S26 , July 2010

The Role of Vasodilating β-Blockers in Patients with Hypertension and the Cardiometabolic Syndrome

  • Addison A. Taylor, MD, PhD

      Affiliations

    • Departments of Medicine, Pharmacology, and Molecular Physiology, Baylor College of Medicine, Houston, Texas, USA
    • Corresponding Author InformationRequests for reprints should be addressed to Addison A. Taylor, MD, PhD, Baylor College of Medicine, 6565 Fannin, MS F504, Houston, Texas 77030
  • ,
  • George L. Bakris, MD

      Affiliations

    • Hypertensive Diseases Unit, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA

References 

  1. Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S.. Diabetes Care. 2005;28:2745–2749
  2. Ballantyne CM. Increasing prevalence of obesity and clustered cardiometabolic risk: can treatment of the underlying cause reverse the trends?. Crit Pathw Cardiol. 2007;6:41–45
  3. Manrique CM, Lastra G, Palmer J, Stump CS, Sowers JR. Hypertension—a treatable component of the cardiometabolic syndrome: challenges for the primary care physician. J Clin Hypertens (Greenwich). 2006;8(suppl 1):12–20
  4. Conen D, Ridker PM, Mora S, Buring JE, Glynn RJ. Blood pressure and risk of developing type 2 diabetes mellitus: the Women's Health Study. Eur Heart J. 2007;28:2937–2943
  5. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus: Atherosclerosis Risk in Communities Study. N Engl J Med. 2000;342:905–912
  6. Smith SC. Multiple risk factors for cardiovascular disease and diabetes mellitus. Am J Med. 2007;120(suppl 1):S3–S11
  7. Golden SH, Folsom AR, Coresh J, Sharrett AR, Szklo M, Brancati F. Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the Atherosclerosis Risk in Communities Study. Diabetes. 2002;51:3069–3076
  8. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–713
  9. Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DR. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med. 2008;359:1565–1576
  10. Kjeldsen SE, Naditch-Brule L, Perlini S, Zidek W, Farsang C. Increased prevalence of metabolic syndrome in uncontrolled hypertension across Europe: the Global Cardiometabolic Risk Profile in Patients with hypertension disease survey. J Hypertens. 2008;26:2064–2070
  11. Cutler JA, Davis BR. Thiazide-type diuretics and β-adrenergic blockers as first-line drug treatments for hypertension. Circulation. 2008;117:2691–2705
  12. Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA. 2003;289:2560–2572
  13. Messerli FH, Bangalore S, Julius S. Risk/benefit assessment of β-blockers and diuretics precludes their use as first-line therapy in hypertension. Circulation. 2008;117:2706–2715
  14. Haenni A, Lithell H. Treatment with a β-blocker with β2-agonism improves glucose and lipid metabolism in essential hypertension. Metabolism. 1994;43:455–461
  15. Pollare T, Lithell H, Selinus I, Berne C. Sensitivity to insulin during treatment with atenolol and metoprolol: a randomized, double-blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients. BMJ. 1989;298:1152–1157
  16. Kasiske BL, Ma JZ, Kalil RSN, Louis TA. Effects of antihypertensive therapy on serum lipids. Ann Intern Med. 1995;122:133–141
  17. Celik T, Iyisoy A, Kursaklioglu H, et al. Comparative effects of nebivolol and metoprolol on oxidative stress, insulin resistance, plasma adiponectin and soluble P-selectin levels in hypertensive patients. J Hypertens. 2006;24:591–596
  18. Jacob S, Rett K, Henriksen EJ. Antihypertensive therapy and insulin sensitivity: do we have to redefine the role of β-blocking agents?. Am J Hypertens. 1998;11:1258–1265
  19. Bakris GL, Fonseca V, Katholi RE, et al. GEMINI Investigators Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA. 2004;292:2227–2236
  20. Luna B, Feinglos MN. Drug-induced hyperglycemia. JAMA. 2001;286:1945–1948
  21. Dahlöf B, Devereux RB, Kjeldsen SE, et al. LIFE Study Group Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003
  22. Dahlöf B, Sever PS, Poulter NR, et al. ASCOT Investigators Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906
  23. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007;369:201–207
  24. Bangalore S, Parkar S, Grossman E, Messerli FH. A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus. Am J Cardiol. 2007;100:1254–1262
  25. Khaw K-T, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European Prospective Investigation into Cancer in Norfolk. Ann Intern Med. 2004;141:413–420
  26. Bristow MR, Nelson P, Minobe W, Johnson C. Characterization of β1-adrenergic receptor selectivity of nebivolol and various other beta-blockers in human myocardium. Am J Hypertens. 2005;18(suppl 4s):51A–52A
  27. Brixius K, Bundkirchen A, Bölck B, Mehlhorn U, Schwinger RH. Nebivolol, bucindolol, metoprolol and carvedilol are devoid of intrinsic sympathomimetic activity in human myocardium. Br J Pharmacol. 2001;133:1330–1338
  28. Weber MA. The role of the new β-blockers in treating cardiovascular disease. Am J Hypertens. 2005;18(pt 2):169S–176S
  29. Mason PR, Kubant R, Jacob RF, Walter MF, Boychuk B, Malinski T, et al. Effect of nebivolol on endothelial nitric oxide and peroxynitrite release in hypertensive animals: role of antioxidant activity. J Cardiovasc Pharmacol. 2006;48:862–869
  30. Cockcroft JR, Chowienczyk PJ, Brett SE, et al. Nebivolol vasodilates human forearm vasculature: evidence for an l-arginine/NO-dependent mechanism. J Pharmacol Exp Ther. 1995;274:1067–1071
  31. Steinberg HO, Baron AD. Vascular function, insulin resistance and fatty acids. Diabetalogia. 2002;45:623–634
  32. Poirier L, Cléroux J, Nadeau A, Lacourcière Y. Effects of nebivolol and atenolol on insulin sensitivity and haemodynamics in hypertensive patients. J Hypertens. 2001;19:1429–1435
  33. Fogari R, Zoppi A, Lazzari P, et al. Comparative effects of nebivolol and atenolol on blood pressure and insulin sensitivity in hypertensive subjects with type II diabetes. J Hum Hypertens. 1997;11:753–757
  34. Kaiser T, Heise T, Nosek L, Eckers U, Sawicki PT. Influence of nebivolol and enalapril on metabolic parameters and arterial stiffness in hypertensive type 2 diabetic patients. J Hypertens. 2006;24:1397–1403
  35. Sarafidis PA, Bakris GL. Metabolic effects of β-blockers: importance of dissociating newer from conventional agents. J Hypertens. 2007;25:249–252
  36. Flather MD, Shibata MC, Coats AJS, et al. SENIORS Investigators Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26:215–225
  37. Rosei EA, Rizzoni D. Metabolic profile of nebivolol, a β-adrenoceptor antagonist with unique characteristics. Drugs. 2007;67:1097–1107
  38. Giles T. Glucose control in hypertensive patients treated with the vasodilating, selective β-blocker, nebivolol. South Med J. 2008;101:863;Poster CAR-4
  39. Sowers J, Whaley-Connell A. Long-term effects of the novel β-blocker, nebivolol, on blood glucose in hypertensive patients. South Med J. 2008;101:863;Poster CAR-3

 Dr. Taylor is supported in part by the National Institutes of Health (NIH).

 Statement of author disclosure: Please see the Author Disclosures section at the end of this article.

PII: S0002-9343(10)00341-4

doi: 10.1016/j.amjmed.2010.04.015

The American Journal of Medicine
Volume 123, Issue 7, Supplement , Pages S21-S26 , July 2010