Hypertension, Dyslipidemia, and Insulin Resistance in Patients With Diabetes Mellitus or the Cardiometabolic Syndrome: Benefits of Vasodilating β-Blockers
Article first published online: 8 NOV 2010
© 2010 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 13, Issue 1, pages 52–59, January 2011
How to Cite
Deedwania, P. (2011), Hypertension, Dyslipidemia, and Insulin Resistance in Patients With Diabetes Mellitus or the Cardiometabolic Syndrome: Benefits of Vasodilating β-Blockers. The Journal of Clinical Hypertension, 13: 52–59. doi: 10.1111/j.1751-7176.2010.00386.x
- Issue published online: 7 JAN 2011
- Article first published online: 8 NOV 2010
- Manuscript received March 29, 2010; revised July 26, 2010; accepted August 14, 2010
Hypertension frequently coexists with diabetes and the cardiometabolic syndrome. β-Blockers have been a mainstay for controlling blood pressure for nearly 4 decades. However, β-blockers are perceived to cause glucose and lipid metabolism dysregulation, including hypoglycemia masking, reduced glycemic control, insulin resistance, and dyslipidemia. It should be noted, however, that β-blockers are diverse in their effects on glucose and lipid metabolism. Potential mechanisms that contribute to these metabolic effects include hemodynamic differences, anti-inflammatory and anti-oxidative pathways, and/or weight changes. Traditional β-blockers decrease cardiac output while peripheral vascular resistance increases or remains unchanged, which may result in glucose and lipid abnormalities. In contrast, vasodilating β-blockers reduce peripheral vascular resistance but have little effect on cardiac output. Vasodilating β-blockers may therefore result in less impact on insulin sensitivity and glycemic control, a reduced new-onset diabetes risk, and improved dyslipidemia compared with traditional β-blockers. Because of these effects, vasodilating β-blockers may represent a favorable option in the treatment of high-risk patients with hypertension. J Clin Hypertens (Greenwich). 2011;13:52–59. ©2010 Wiley Periodicals, Inc.