A Meta-Analysis of 94,492 Patients With Hypertension Treated With Beta Blockers to Determine the Risk of New-Onset Diabetes Mellitus
Sheba Medical Center, Gan, Tel Aviv, IsraelThe American Journal of Cardiology (Impact Factor: 3.28). 10/2007; 100(8):1254-62. DOI: 10.1016/j.amjcard.2007.05.057
Beta blockers used for the treatment of hypertension may be associated with increased risk for new-onset diabetes mellitus (DM). A search of Medline, PubMed, and EMBASE was conducted for randomized controlled trials of patients taking beta blockers as first-line therapy for hypertension with data on new-onset DM and follow-up for > or =1 year. Twelve studies evaluating 94,492 patients fulfilled the inclusion criteria. Beta-blocker therapy resulted in a 22% increased risk for new-onset DM (relative risk 1.22, 95% confidence interval [CI] 1.12 to 1.33) compared with nondiuretic antihypertensive agents. A higher baseline fasting glucose level (odds ratio [OR] 1.01, 95% CI 1.00 to 1.02, p = 0.004) and greater systolic (OR 1.05, 95% CI 1.05 to 1.08, p = 0.001) and diastolic (OR 1.06, 95% CI 1.01 to 1.10, p = 0.011) blood pressure differences between the 2 treatment modalities were significant univariate predictors of new-onset DM. Multivariate meta-regression analysis showed that a higher baseline body mass index (OR 1.17, 95% CI 1.01 to 1.33, p = 0.034) was a significant predictor of new-onset DM. The risk for DM was greater with atenolol, in the elderly, and in studies in which beta blockers were less efficacious antihypertensive agents and increased exponentially with increased duration on beta blockers. For the secondary end points, beta blockers resulted in a 15% increased risk for stroke, with no benefit for the end point of death or myocardial infarction. In conclusion, beta blockers are associated with an increased risk for new-onset DM, with no benefit for the end point of death or myocardial infarction and with a 15% increased risk for stroke compared with other agents. This risk was greater in patients with higher baseline body mass indexes and higher baseline fasting glucose levels and in studies in which beta blockers were less efficacious antihypertensive agents compared with other treatments.
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- "Additionally , beta-blockade does not contribute to increasing the risk of hypoglycemia , even among patients prone to hypoglycemia (Sawicki and Siebenhofer, 2001). Hence, despite the fact that propranolol might increase the risk of new-onset diabetes (Bangalore et al., 2007; Gupta et al., 2008), the true effect of nonselective beta-blockade upon diurnal glycemic control, if any, has not been demonstrated yet, especially in insulin-treated subjects. "
ABSTRACT: Objective: Unequivocal modulation of glycemic homeostasis by chronic beta-adrenergic blockade in diabetes has never been demonstrated. This study investigates the participation of beta-adrenergic system in glycemic control and muscle glucose transporter GLUT4 expression in insulin-treated diabetic rats. Methods: Insulin-treated diabetic Wistar (W) or spontaneously hypertensive rats (SHR) were additionally treated with propranolol, and glycemic homeostasis and expression of some target mRNAs and proteins in soleus and extensor digitorum longus (EDL) muscles were analyzed. Results: Insulin improved glycemic control in both strains. Importantly, in W, propranolol promoted a further improvement in glycemic control, which was accompanied by decreased PKA and Tnf expression, and increased Slc2a4 and GLUT4 in EDL. Those effects were not observed in diabetic-SHR. Discussion: Propranolol-induced decrease in beta-adrenergic activity in skeletal muscles of insulin-treated diabetic Wistar rats increases GLUT4 expression in EDL, improving glycemic control. These outcomes represent a positive effect of nonselective beta-blockade, which might be extended to autonomic neuropathy.
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- "Számos probléma merült fel ezzel kapcsolatban. Például Bangalore és munkatársai 2007-ben egy 94 000 fős metaanalízisben a hagyományos β-blokkoló kezelés mellett újonnan kialakuló diabetes mellitus arányát összehasonlították az egyéb vérnyomáscsökkentő kezelés mellett tapasztalható esetekkel . Azt tapasztalták, hogy β-blokkoló kezelés mellett 22%-kal, szignifikáns mértékben gyakoribb volt a 2-es típusú diabetes kialakulása az egyéb, nem diureti kum alapú antihipertenzív kezeléssel szemben. "
ABSTRACT: The choice of treatment of patients with hypertension should not be based solely on the blood pressure value, because the risk of cardiovascular diseases are influenced by the presence and magnitude of other risk factors, too. The presence of a metabolic disease (diabetes mellitus, metabolic syndrome) itself categorizes the patient as a high risk individual. In such cases the use of combined treatment is usually considered. For example, in case of hypertension aggraviated by left ventricular dysfunction, ischaemic heart disease or cardiac insufficiency, β-blocker treatment is usually included in the combination of the first setting. Orv. Hetil., 2015, 156(16), 623-625.
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- "The decline was time-related to the introduction of the 2006 NICE guidelines . In addition to guidelines, general practitioners aware of some evidence that beta blockers may be less effective at reducing blood pressure , as well as of their association with new onset diabetes  may contribute to the constant reduction in BB use over the period. However opposite trends in BB prescribing have also been observed. "
ABSTRACT: In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger non-black patients (OR 0.16, 95% CI 0.12 - 0.21) and older non-black patients (OR 0.49, 95% CI 0.37 - 0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19 - 1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17 - 1.91) but not in older non-black patients (OR 0.58, 95% CI 0.46 - 0.74). The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups.
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