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