Med. praxi. 2014;11(6):257-264

Doubts about beta-blockers: diabetes mellitus, hypoglycaemia and dyslipidemia

PharmDr.Michal Prokeš, PharmDr.Josef Suchopár
INFOPHARM a.s., Praha

Beta-blockers are a heterogenous group of drugs commonly prescribed for the treatment of patients with hypertension, tachyarrhytmias

and heart failure. Although prolongation of hypoglycaemia and masking of hypoglycaemia was reported for some beta-blockers, for

example propranolol, studies with selective beta-blockers brought conflicting results and population-based studies did not found association

between the use of beta-blockres and the risk of hypoglycaemia. An unfavourable metabolic profile of beta-blockers was also

reported such as an insuline resistance and dyslipidemia. The evidence is based on studies with weakly-selective or non-selective agents.

Newer generation of beta-blockers appear to have the metabolic profile neutral. Beta-blockers should be prescribed where indicated

also to patients with diabetes mellitus, with the preferential use of newer type of beta-blockers should be considered.

Keywords: beta-blockers safety profile, hypoglycaemia, metabolic side effects

Published: December 1, 2014  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Prokeš M, Suchopár J. Doubts about beta-blockers: diabetes mellitus, hypoglycaemia and dyslipidemia. Med. praxi. 2014;11(6):257-264.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Sawicki PT, Siebenhofer A. Betablocker treatment in diabetes mellitus. J Intern Med 2001; 250: 11-7. Go to original source... Go to PubMed...
    2. Bultas J. Blokátory adrenergních receptorů, in: Remedia compendium, čtvrté vydání, Panax 2009: 80-90.
    3. Vítovec J, Špinar J. Přehled současných moderních betablokátorů v léčbě kardiovaskulárních onemocnění. Praktické lékárrenství 2008; 4(4): 162-165.
    4. Fischman WHo, Saunders E. ?-adrenercic blockers. J Clin Hypertens (Greenwich): 2011; 13: 649-653. Go to original source...
    5. Barrese V, Taglialatela M. New advances in beta-blocker therapy in heart failure. Frontiars in physiology 2013; 4: Article 323, 1-9. Go to original source...
    6. Widimský J jr. Beta-blokátory v léčbě kardiovaskulárních onemocnění: postavení nebivololu. Practicus 2013; 9-10: 27-29.
    7. Kotler MN, Berman L, Rubenstein AH. Hypoglycaemia precipitated by propranolol. Lancet 1966; 2: 1389-1390. Go to original source... Go to PubMed...
    8. Lloyd-Mostyn RH, Oram S. Modification by propranolol of cardiovascular effects of induced hypoglycaemia. Lancet 1975: 1213-1215. Go to original source... Go to PubMed...
    9. Davidson NMcD, Corral RJM, Shaw TRD, French EB. Observations in man of hypoglycaemia during selective and non-selective beta-blodkade. Scott Med J 1976; 33: 69-72. Go to original source...
    10. Newman RJ. Comparison of propranolol, metoprolol, and acebutolol on insulin-induced hypoglycaemia. Br Med J 1976; 2: 447-449. Go to original source... Go to PubMed...
    11. Deacon SP, Barnett D. Comparison of atenolol and propranololl during insulin-induced hypoglycaemia. Br Med J 1976; 2: 272-273. Go to original source... Go to PubMed...
    12. Viberti GC, Keen H, Bloom SROV. Beta blockade ant diabetes mellitus: Effect of oxprenolol ana medoprolol on the metabolic, cardiovascular, and hormonal response to insulin-induced hypoglycemia in normal subjects. Metabolism, 1980; 9: 866-872. Go to original source... Go to PubMed...
    13. Deacon SP, Karunanayake A, Bernett D. Acebutolol, atenolol, and propranolol and metabolic resposnes to acute hypoglycaemia in diabetics. Br Med J 1977; 2: 1255-1257. Go to original source... Go to PubMed...
    14. Östman J, Arner P, Haglund K, et al. Effect of metoprolol and alprenolol on the metabolic, hormonal, and haemodynamic repsonse to insulin-induced hypoglycaemia in hypertensive, insulin-dependent diabetics 1982; 211: 381-385. Go to original source... Go to PubMed...
    15. Schlütler KJ, Aellig WH, Petersen KG, et al. The influence of ?-adrenoreceptor blocking drugs with and without intrinsic sympathomimetic aktivity on the hormonal responses to hypo- and hyperglycaemia. Br J clin Pharmac 1982; 12: 407S-417S. Go to original source... Go to PubMed...
    16. Saunders J, Gomeni R, Kilborn JR, et al. A comparison between propranolol, practolol and betaxolol (SL75212) on the circulatory and metabolic responses to insulin-induced hypoglycaemia. Eur J Clin Pharmacol 1981; 21: 177-184. Go to original source... Go to PubMed...
    17. Ryan JR, Lacorte W, Jain A, McMahon FG. Response of diabetics treated with atenolol or propranolol to insulin-induced hypoglycaemia. Drugs 1983; 25(Suppl), 256-257. Go to original source...
    18. Leopold G, Ungethüm W, Pabst J, et al. Pharmacodynamic profile of bisoprolol, a new ?1-selective adrenoceptor antagonist. Br J clin Pharmac 1986; 22: 293-300. Go to original source... Go to PubMed...
    19. Kerr D, MacDonald IS, Heller SR, Tattersall RR. ?-adrenoceptor blockade and hypoglycaemia. A randomized, double-blind, placebo controlled comparison of metoprolol CR atenolol and propranolol LA in normal subjects. Br J Clin Pharmacol 1990; 29: 685-693. Go to original source... Go to PubMed...
    20. Herrings RM, de Boer A, Stricker BHCh et al. Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme. Lancet 1995; 345: 1195-1198. Go to original source... Go to PubMed...
    21. Morris AD, Boyle DIR, McMahon AD, et al. ACE inhibitor use is associated with hospitalisation for severe hypoglycemia in patients with diabetes. Diabetes Care 1997; 20: 1363-1367. Go to original source... Go to PubMed...
    22. Shorr RI, Ray WA, Daugherty JR, et al. Antihypertensives ant hte risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278(1): 40-43. Go to original source...
    23. Thamer M, Ray NF, Taylor T. Association between antihypertensive drug use and hypoglycemia: A case-control study of diabetic users of insulin or sulfonylureas. Clin Ther 1999; 21(8): 1387-1400. Go to original source... Go to PubMed...
    24. Bangalore S, Parkar S, Grossman E, Messerli FH. A meta-analysis of 94492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus. Am J Cardiol 2007; 100(8): 1254-1262. Go to original source... Go to PubMed...
    25. Belknap S. Review: beta-blockers for hypertension increase risk of new-onset diabetes compared with nondiuretic antihypertensive agents. ACP J Club 2008; 148(2): 38. Go to original source... Go to PubMed...
    26. Ram CV. Risk of new-onset diabetes mellitus in patients with hypertension treated with beta blockers. Am J Cardiol 2008; 102(2): 242-244. Go to original source... Go to PubMed...
    27. UK Prospective Diabetes Study Group: Efiicacy of atenolol and captopril in reducing risk of macrovacsular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J 1998; 317: 713-720. Go to original source... Go to PubMed...
    28. Gress TW, Nieto JF, Shahar E, et al. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J Med 2000; 342: 905-912. Go to original source... Go to PubMed...
    29. Rizos E, Bairaktari E, Kostoula A, et al. The combination of nebivolol plus pravastatin is associated with a more beneficial metabolic profile compared to that of atenolol plus pravastatin in hypertensive patients with dyslipidemia: a pilot study. J Cardiovasc Pharmacol therapeut 2003; 8: 127-134. Go to original source... Go to PubMed...
    30. Bakris GL, Fonseca V, Katholi RE, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 2004; 292: 2227-2236. Go to original source... Go to PubMed...
    31. Fonarow GC, Deedwania P, Fonseca V, et al. Differential effects of extended-release carvedilol and extended-release metoprolol on lipid profiles in patients with hypertension: results on the Extended-Release Carvedilol Lipid Trial.
    32. Torp-Pedersen C, metra M, Charlesworth A, et al. Effects of metoprolol and cervedilol on pre-existing and new onset diabetes in patients with chronic heart failure: data from the Carvedilol Or Metoprolol european Trial (COMET). Heart 2007; 93: 968-973. Go to original source... Go to PubMed...
    33. Wai B, Kearney LG, Hare DL, et al. Beta blocker use in subjects with type 2 diabetes mellitus and systolic heart failure does not worsen glycaemic control. Cardivasc Diabetol 2012; Feb 14;11:14. doi: 10.1186/1475-2840-11-14.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298480/. Go to original source... Go to PubMed...
    34. Janka HU, Ziegler AG, Larrat V, Mehnert H. The effect of the beta 1 selective beta blocker, betaxolol, on metabolism in type II diabetics. Arzneimittelforschung 1989; 39(5): 615-617.
    35. Fogari R, Zoppi A, Corradi L, et al. Beta-blocker effects on plasma lipids during prolonged treatment of hypertensive patients with hypercholesterolemia. J Cardiovasc Pharmacol 1999; 33(4): 534-539. Go to original source... Go to PubMed...
    36. Malminiemi K, Lahtela J, Malminiemi O, et al. Insulin sensitivity in a long-term crossover trial with celiprolol and other antihypertensive agents. J Cardiovasc Pharmacol 1998; 31(1): 140-145. Go to original source... Go to PubMed...
    37. Karen I, Filipovský J. Arteriální hypertenze, novelizace 2004. Doporučené diagnostiké a terapeutické postupy pro všeobecné praktické lékaře. http://www.svl.cz/files/files/Doporucene-postupy-od-2013/DP-AH-2014.pdf.

    Return to the content


    Medicine for Practice

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.