Hypertension, Dyslipidemia, and Insulin... : Journal of Clinical Hypertension (original) (raw)

Hypertension, Dyslipidemia, and Insulin Resistance in Patients With Diabetes Mellitus or the Cardiometabolic Syndrome

Benefits of Vasodilating β-Blockers

Prakash Deedwania

Journal of Clinical Hypertension

(

)

January 2011

| DOI: 10.1111/j.1751-7176.2010.00386.x

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.