The role of vasodilating beta-blockers in patients with hypertension and the cardiometabolic syndrome

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 beta-blockers in patients with these conditions continues to be a subject of intense debate, given the adverse metabolic effects associated with conventional beta-blockers. Data on vasodilating beta-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 beta-blockers to patient populations traditionally considered not to be optimal candidates for beta-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.