Effect of Beta - Blockers on Insulin Resistance in Patients with Hypertension and Metabolic Syndrome after 6 Months of Treatment
Journal Title: Journal of Endocrinology and Diabetes - Year 2017, Vol 4, Issue 2
Abstract
Background:For years the use of beta-blockers in patients with metabolic syndrome has been limited due to the negative impact of non-selective beta - blockers on carbohydrate and lipid metabolism. Aim:We studied antihypertensive therapy with different beta - blockers over 6 months on the impact on insulin resistance, lipid metabolism and blood pressure in patients with mild to moderate hypertension and metabolic syndrome. Materials and Methods: Participants in this study came from a single clinic in Kiev, Ukraine attending a specialized hypertension clinic. This report includes 131 patients with mild to moderate hypertension and metabolic syndrome according to ATP III criteria without diabetes. There were 71 (54%) males and 60 females. All patients had office and ambulatory blood pressure measurements, fasting blood glucose and lipid levels. Glucose and insulin levels were assessed during a glucose tolerance test (PGTT) at baseline and after 6 months. The HOMA index was calculated. For 7 days before all medications was stopped. Hydrochlorothiazide was added if needed for BP control. Results: The mean follow-up - 6.30 ± 0.60 months. The mean age - 49.49 ± 1.05 years. The body weight - 93.74 ± 1.21 kg. The body mass index (BMI) - 32.05 ± 0.35 kg/m2 and was not changed during 6 months. Baseline office SBP and DBP were 154.21 ± 0.71 and 87.20 ± 0.73 mmhg accordingly. The baseline HR - 71.90 ± 0.62 beats/min. Mean SBP/DBP24 - 135.20 ± 1.13 mmhg/79.27 ± 0.87 mmhg. HR24 - 72.28 ± 0.89 beats/ min. During treatment with atenolol, carvedilol, bisoprolol and nebivolol mean SBP/DBP24 reduction did not differ between the groups: 16.86, 15.40, 16.26 and 17.00 mmhg respectively (p< 0.05 for all values) and 10.67, 9.00, 12.72 and 10.03 mmhg respectively (p< 0.05 for all values) and significantly decreased HR24 4.00, 3.92, 3.82 and 3.54 beats/min respectively (p< 0,05 for all). Glucose levels in the atenolol group increased at all three points of PGTT. Increased fasting insulin level is a sign of the progression of insulin resistance in group of atenolol. The percentage of patients with identified insulin resistance (HOMA>3) increased from 34.4% to 71.9% (p < 0.05). According to PGTT Score there were 6 (18.7%) cases of onset diabetes. Carvedilol therapy contributed to a significant, reduction in fasting insulin. Fasting insulin decreased by 22.8% (p < 0.05), HOMA index decreased by 21.7% (p < 0.05), and serum glucose did not change significantly. The percentage of patients whose HOMA index >= 3 decreased from 31.3% to 18.8%. In the carvedilol group, there were 2 with onset diabetes (6.3%). Bisoprolol significantly decreased HOMA index by 17.4% (p< 0.05), fasting insulin by 10.7% (p < 0.05), fasting glucose by 10% (p < 0.05). This group also demonstrated a positive trend toward HOMA index >3 (at baseline - 34.4% of patients at the end of the study - 12.5%). There was also one case of the onset diabetes (3.2%). In the nebivolol group the HOMA index decreased from 2.3 ± 0.3 to 1.76± 0.1 mmol/l (p < 0.05), and fasting glucose decreased by 7.4% (p< 0.05); no cases of onset diabetes were recorded. The proportion of patients with manifest insulin resistance decreased from 34.3% to 2.9% (p < 0.05). Carvedilol treatment reduced levels of total cholesterol, TG, LDL cholesterol, VLDL cholesterol, IA; the level of HDL cholesterol was unchanged. TG levels decreased from 1.86 ± 0.14 to 1.44 ± 0.15 mmol/l (p< 0.05) and total cholesterol from 6.29 ± 0.14 to 5.86 ± 0.25 mmol/l (p>0,05). In the bisoprolol group TG decreased from 1.67 ± 0.13 mmol/l to 1.58 ± 0.15 mmol/l, (p>0,05) and total cholesterol decreased from 6.35 ± 0.19 mmol/l to 5.78 ± 0.18 mmol/l (p=0,02). In the nebivolol group TG decreased from 1.74 ± 0.15 mmol/l to 1.23 ± 0.06 mmol/l, and total cholesterol decreased from 6.12 ± 0.25 mmol/l to 5.44± 0.20 mmol/l (p < 0.01 for both values). In the atenolol group TG and total cholesterol changed not statistical significant. The levels of TG and VLDL in nebivolol group decreased from 29.4% and 25% respectively. Reduction of TG and VLDL in the carvedilol group was slightly lower about 21.0%and 12.5% respectively. Reduction of TG and VLDL in the Bisoprolol group was the lowest only 5.9% and 12.5%, respectively. Conclusions:This study showed that all four beta-blockers had similar BP lowering but different metabolic effects. There was a significant worsening of insulin resistance in patients receiving atenolol. Bisoprolol can be used as metabolically neutral drugs in patients with mild to moderate hypertension, clinical signs of metabolic syndrome and manifestations of insulin resistance without diabetes. Patients treated with nebivolol and carvedilol had a trend toward more improvement in insulin sensitivity and glucose tolerance. Nebivolol and carvedilol therapy significantly improved glycemic profile, which may improve prognosis. Nebivolol and carvedilol may be recommended as a drug of choice in patients with hypertension and metabolic syndrome with signs of impaired carbohydrate metabolism.
Authors and Affiliations
Yuriy Sirenko, Oksana Rekovets, Olena Torbas, Sergey Savitskiy, Evgenia Pavlyuk
Keywords
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- EP ID EP333758
- DOI 10.15226/2374-6890/4/2/00175
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