Beta-blocking agents in patients with insulin resistance: Effects of vasodilating beta-blockers

Stephan Jacob, Bernd Balletshofer, Erik J. Henriksen, Annette Volk, Birgit Mehnert, Klaus Löblein, Hans Ulrich Häring, Kristian Rett

Research output: Contribution to journalReview article

53 Scopus citations

Abstract

Essential hypertension is - at least in many subjects - associated with a decrease in insulin sensitivity, while glycaemic control is (still) normal. It seems that in hypertensive patients, two major functions of insulin are impaired: there is insulin resistance of peripheral glucose uptake (primarily skeletal muscle) and insulin resistance of insulin-stimulated vasodilation. In view of some retrospective data and meta-analyses, which showed a less than expected reduction in coronary events (coronary paradox), the metabolic side effects of the antihypertensive treatment have received more attention. Many groups have shown that conventional antihypertensive treatment, both with beta-blockers and/or diuretics, decreases insulin sensitivity by various mechanisms. While low-dose diuretics seem to be free of these metabolic effects, there is no evidence for this in the β-adrenergic blockers. However, recent metabolic studies evaluated the effects of vasodilating beta- blockers, such as dilevalol, carvedilol and celiprolol, on insulin sensitivity and the atherogenic risk factors. None of them decreased insulin sensitivity, as has been described for the beta-blockers with and without β1 selectivity. This supports the idea that peripheral vascular resistance and peripheral blood flow play a central role in mediating the metabolic side effects of the beta-blocking agents, as the vasodilating action (either via β2 stimulation or α1-blockade) seems to more than offset the detrimental effects of the blockade of β (or β1) receptors. Further studies are needed to elucidate the relevance of the radical scavenging properties of these agents and their connection to their metabolic effects. Therefore, the beneficial characteristics of these newer beta-adrenoreceptor blockers suggest that the vasodilating beta-blocking agents could be advantageous for hypertensive patients with insulin resistance or type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)261-268
Number of pages8
JournalBlood Pressure
Volume8
Issue number5-6
DOIs
StatePublished - Jan 1 1999

Keywords

  • Antihypertensive treatment
  • Atherogenic risk factors
  • Betablocking agents
  • Insulin sensitivity
  • Vasodilating beta-blocker

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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    Jacob, S., Balletshofer, B., Henriksen, E. J., Volk, A., Mehnert, B., Löblein, K., Häring, H. U., & Rett, K. (1999). Beta-blocking agents in patients with insulin resistance: Effects of vasodilating beta-blockers. Blood Pressure, 8(5-6), 261-268. https://doi.org/10.1080/080370599439463