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

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Abstract

In the United States, a vast segment of the adult population is classified as having the cardiometabolic syndrome, and currently there are epidemic rates of both type 2 diabetes mellitus and obesity. Hypertension is closely linked with these metabolic disorders and is a strong independent predictor of incident type 2 diabetes. In addition, hypertension is an important contributor to increasing cardiovascular disease risk in patients with the cardiometabolic syndrome. Lowering elevated blood pressure in patients with the cardiometabolic syndrome or diabetes is a critical component of reducing global cardiovascular risk. However, aggressive management of hypertension in these patients is often challenging, and the presence of these conditions is associated with poor blood pressure control. The utility of β-blockers in patients with these conditions continues to be a subject of intense debate, given the adverse metabolic effects associated with conventional β-blockers. Data on vasodilating β-blockers, however, suggest that these agents have favorable or neutral metabolic effects and generally more favorable effects when compared with nonvasodilating members of this class. These agents may expand the utility of β-blockers to patient populations traditionally considered not to be optimal candidates for β-blocker therapy—a fact which has important clinical implications, because more antihypertensive agents are needed to diversify the therapeutic options available for clinicians treating hypertension in patients with the cardiometabolic syndrome or type 2 diabetes.

Section snippets

Metabolic Effects of Conventional β-Blockers

Despite the recommendations for β-blocker use in patients with hypertension at high risk for CVD, including patients with diabetes, in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7),12 the utility of β-blockers in patients with the cardiometabolic syndrome or type 2 diabetes was debated vigorously.11, 13 Abnormalities of glucose, insulin, and lipid and carbohydrate metabolism have been reported frequently

Aggressive Management of Hypertension in Patients with the Cardiometabolic Syndrome: The Role of Vasodilating β-Blockers

The β-blockers included in the meta-analyses and other reports in the literature predominantly are older, conventional agents of this class. β-Blockers comprise a highly heterogeneous class of agents, however, with a range of pharmacologic, hemodynamic, and metabolic effects. In the meta-analysis reported by Kasiske and colleagues,16 for example, the increase in triglycerides seen with β-blockers overall was smaller with cardioselective β-blockers and those with intrinsic sympathomimetic

Summary

Clearly, more agents are needed to diversify the antihypertensive armamentarium and to provide more choices for clinicians in achieving the recommended aggressive blood pressure control for patients with the cardiometabolic syndrome or type 2 diabetes. To this end, data on vasodilating β-blockers, such as nebivolol, carvedilol, and labetalol, suggest that these agents have favorable or neutral metabolic effects, and generally more favorable effects, when compared with older, nonvasodilating

Author Disclosures

The authors who contributed to this article have disclosed the following industry relationships:

  • Addison A. Taylor, MD, PhD, is a member of the Speakers' Bureaus of Abbott Laboratories, Boehringer Ingelheim, Forest Laboratories, Inc., GlaxoSmithKline, Merck & Co., Inc., and Novartis AG; has worked as a consultant to Abbott Laboratories, Boehringer Ingelheim, Forest Laboratories, Inc., GlaxoSmithKline, Merck & Co., Inc., and Novartis AG; has served on the advisory boards of Abbott Laboratories,

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    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.

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