Re: atenolol and insulin resistance



On Apr 3, 8:14 pm, "bigvince" <Vince.Mirag...@xxxxxxxxx> wrote:
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Hemodynamic and metabolic responses to valsartan and atenolol in obese
hypertensive patients.Jordan J, Engeli S, Boschmann M, Weidinger G,
Luft FC, Sharma AM, Kreuzberg U.
Franz-Volhard Clinical Research Center, Medical Faculty of the Charite
and Helios Klinikum, Berlin, Germany. jor...@xxxxxxxxxxxxxxxxxxx

OBJECTIVE: None of the current hypertension guidelines provides
specific guidance regarding pharmacological management of obese
hypertensive patients. Treatment recommendations for lean
hypertensives may not be simply extrapolated to obese hypertensive
persons. DESIGN: Randomized, double-blind, parallel-group study with a
13-week treatment period. SETTING: Multicenter study in Germany.
PATIENTS: Obese patients with mild to moderate uncomplicated essential
hypertension. INTERVENTION: Patients were treated with valsartan at a
maximal dose of 160 mg/day or with atenolol at a maximal dose of 100
mg/day. Hydrochlorothiazide at doses of 12.5-25 mg was added in
patients with blood pressure > 140/90 mmHg on monotherapy. MAIN
OUTCOME MEASURES: Blood pressure, lipid and glucose metabolism, and
highly sensitive C-reactive protein (hsCRP) were monitored. RESULTS:
Sixty-seven patients were randomized to valsartan and 65 patients to
atenolol. With valsartan, systolic blood pressure (SBP) decreased from
160.8 +/- 8.9 to 140.5 +/- 13.3 mmHg and diastolic blood pressure
(DBP) from 96.1 +/- 7.0 to 85.1 +/- 8.1 mmHg by the end of the study.
With atenolol, SBP decreased from 159.3 +/- 6.8 to 139.8 +/- 14.5 mmHg
and DBP from 95.0 +/- 6.8 to 83.5 +/- 7.5 mmHg (P = 0.91 for SBP and P
= 0.34 for DBP between interventions). Body weight did not change with
either treatment. We did not see a significant difference in the
response of lipid levels or hsCRP between interventions. To assess the
cumulative effect of each intervention on glucose metabolism over the
trial duration, we calculated individual areas under the curve for
homeostasis model assessment for insulin resistance (HOMA-IR) over
time. The resulting area under the curve was significantly smaller
with valsartan compared with atenolol (P = 0.02). CONCLUSIONS: Beta-
adrenoreceptor blockers and AT1-receptor blockers, particularly in
combination with low-dose diuretics, effectively lower blood pressure
in obese hypertensives. However, metabolic responses differ between
both treatment strategies, with beneficial effects of AT1-receptor
blockers. AT1-receptor blockers are a good choice in obese
hypertensives, given the profoundly increased diabetes risk in this
population.

PMID: 16269974 [PubMed - indexed for MEDLINE]

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Mar 30 2007 06:45:50

Antihypertensive efficacy and tolerability of two fixed-dose

Clin Ther. 2005 Jul;27(7):1013-21.

More on atenolols negative effect on insulin resistance1: J Hum
Hypertens. 2000 Mar;14(3):175-80. Links
Induction of insulin resistance by beta-blockade but not ACE-
inhibition: long-term treatment with atenolol or trandolapril.Reneland
R, Alvarez E, Andersson PE, Haenni A, Byberg L, Lithell H.
Uppsala University, Uppsala, Sweden.

The effects on glucose metabolism by the beta-blocker atenolol and the
angiotensin-converting enzyme (ACE)-inhibitor trandolapril were
investigated in a randomised double-blind parallel group study of
patients with primary hypertension. Twenty-six patients were treated
with 50-100 mg atenolol and 27 patients with 2-4 mg trandolapril o.d.
Intravenous glucose tolerance tests, euglycaemic hyperinsulinaemic
clamps and serum lipid measurements were performed after 8 and 48
weeks of active treatment. After 48 weeks insulin sensitivity was
reduced by 23% by atenolol while it remained unchanged during
trandolapril treatment (+0.5%, P = 0.0010 for difference between
treatments, ANCOVA). The effect on triglycerides (+22% vs -8.5%) and
high-density lipoprotein cholesterol (-13% vs +0.7%) also differed
significantly between atenolol and trandolapril. Results after 8 weeks
were similar. Glucose tolerance was not affected by either drug.
Atenolol reduced diastolic blood pressure (DBP) better than
trandolapril (-15.3 mm Hg vs -6.6 mm Hg for supine DBP after 48 weeks,
P = 0.012). The difference in effect on insulin sensitivity between
the drugs corresponded to 25% of the baseline values of insulin
sensitivity, and persisted over 48 weeks of treatment. The choice of
antihypertensive treatment could influence the risk of diabetes
associated with treated hypertension. Journal of Human Hypertension
(2000) 14, 175-180.

PMID: 10694831 [PubMed - indexed for MEDLINE]
Related LinksControlled study of the effect of angiotensin converting
enzyme inhibition versus calcium-entry blockade on insulin sensitivity
in overweight hypertensive patients: Trandolapril Italian Study
(TRIS). [J Hypertens. 1999] PMID: 10100083 Antihypertensive therapy
with verapamil SR plus trandolapril versus atenolol plus
chlorthalidone on glycemic control. [Am J Hypertens. 2003] PMID:
12745200 Comparative effects of nebivolol and atenolol on blood
pressure and insulin sensitivity in hypertensive subjects with type II
diabetes. [J Hum Hypertens. 1997] PMID: 9416986 Sensitivity to insulin
during treatment with atenolol and metoprolol: a randomised, double
blind study of effects on carbohydrate and lipoprotein metabolism in
hypertensive patients. [BMJ. 1989] PMID: 2500169 Insulin sensitivity
following treatment with the alpha 1-blocker bunazosin retard and the
beta 1-blocker atenolol in hypertensive non-insulin-dependent diabetes
mellitus patients. [J Hypertens. 1996] PMID: 8986932 See all Related
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