Lowering Blood Pressure With β-Blockers in Combination With Other Renin-Angiotensin System Blockers in Patients With Hypertension and Type 2 Diabetes: Results From the GEMINI Trial

Authors

  • Jackson T. Wright Jr MD, PhD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 1 George L. Bakris MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 2 David S. H. Bell MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 3 Vivian Fonseca MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 4 Richard E. Katholi MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 5 Janet B. McGill MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 6 Franz H. Messerli MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 7 Robert A. Phillips MD, PhD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 8 Philip Raskin MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 9 Fred K. Holdbrook PhD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • 10 Mary Ann Lukas MD,

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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  • and 10 Malini Iyengar PhD 10

    1. From the Department of Medicine, Case Western Reserve University, Cleveland, OH;1the Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL;2the Department of Medicine, University of Alabama, Birmingham, AL;3the Department of Medicine, Tulane University, New Orleans, LA;4the Department of Medicine, St John's Hospital, Springfield, IL;5the Department of Medicine, Washington University School of Medicine, St Louis, MO;6the Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY;7the Department of Medicine, University of Massachusetts Medical School, Worcester, MA;8the Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX;9 and GlaxoSmithKline, Philadelphia, PA10
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Jackson T. Wright Jr, MD, PhD, Division of Nephrology and Hypertension, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106
E-mail: jackson.wright@case.edu

Abstract

The effects of β-blockade in addition to more specific renin-angiotensin system (RAS) blockers on blood pressure (BP) in patients with diabetes are described. After washout of medications other than angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, patients were titrated to a BP level <130/80 mm Hg using therapy with carvedilol 6.25 to 25 mg bid (n=498) or metoprolol tartrate 50 to 200 mg bid (n=737). At the end of the β-blocker titration period, a BP level <130/80 mm Hg was achieved in 37% of carvedilol-treated and 36% of metoprolol-treated participants who continued to receive a renin-angiotensin system blocker. In the approximately 60% of participants in whom a BP level <130/80 mm Hg was not attained with renin-angiotensin system blockade plus β-blockade, hydrochlorothiazide was added in 43% and 44% of carvedilol and metoprolol groups, respectively; 25% (both arms) also required a calcium channel blocker. Among those in whom goal BP was not achieved, 42% of carvedilol- and 40% of metoprolol-treated participants were not titrated to the highest dose of β-blocker. The use of carvedilol compared with metoprolol did not effect glycemic control.

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