Antihypertensive treatment with beta-blockers in the metabolic syndrome: a review.
Metabolic syndrome, a "cluster" of metabolic disorders including hypertension, increases the cardiovascular risk, and insulin resistance plays a key role in its pathogenesis. In this syndrome antihypertensive treatment with beta-blockers is underused because of their adverse metabolic effects. The aim was to review the evidences supporting the reasons for underusing beta-blockers in hypertensive patients with metabolic syndrome. A review of Literature has been carried out via PubMed from 1998 to 2008: most of beta-blockers have adverse effects on insulin sensitivity, carbohydrate and lipid metabolism, and are not recommended in metabolic syndrome. However, some recent large studies have shown a better metabolic profile with newer third generation vasodilating beta-blockers, such as Carvedilol and Nebivolol. Vasodilating action of Carvedilol and Nebivolol, due respectively to alpha1-blocking effect and release of nitric oxide, explains the lack of adverse metabolic effects of these beta-blockers that could also be used in hypertensive patients with metabolic syndrome.
Carella
Angelo M
AM
Department of Internal Medicine, T. Masselli-Mascia Hospital, San Severo, Foggia, Italy. mic.carella@virgilio.it
Antonucci
Giuseppe
G
Conte
Matteo
M
Di Pumpo
Michele
M
Giancola
Armando
A
Antonucci
Elisabetta
E
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001578:Benzopyrans / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D004983:Ethanolamines / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D024821:Metabolic Syndrome / Q000150:complications / Q000188:drug therapy*; D008954:Models, Biological; D000068577:Nebivolol; D011412:Propanolamines / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001578:Benzopyrans; D002227:Carbazoles; D004983:Ethanolamines; D011412:Propanolamines; D014665:Vasodilator Agents; D000068577:Nebivolol; D000077261:Carvedilol