Beta Blockers

Beta-blockers are known to impair glucose tolerance or even precipitate overt diabetes in non-diabetic individuals. These deleterious effects are more pronounced with nonspecific beta agonists like propranolol or beta-1 selective like metoprolol (23) compared to beta-blockers with alpha-blocking activity like carvedilol (24). In Atherosclerosis Risk In Communities (ARIC) study, a prospective study of 12,550 adults by Gress et al. (25), beta-blockers increased the risk for subsequent diabetes by 28% among hypertensive patients compared with hypertensive patients not receiving any therapy. Moreover, in the recent trials, the incidence of diabetes was highest with the use of beta-blockers, Atenolol vs. Losartan in LIFE (The Losartan Intervention (26) For End point Reduction trial, Verapamil vs. conventional therapy i.e., beta-blockers in COVINCE (Controlled Onset Verapamil Investigation of Cardiovascular End Points) (27) and INVEST (International Verapamil SR-Trandopril Study) (28). Table 2 provides a summary of 11 randomized clinical outcome trials where development of new-onset diabetes was evaluated as a secondary endpoint.

The mechanisms by which beta-blockers impair glucose tolerance are not completely understood. The degree of lipophilicity seems to be an important determinant factor (29). Other contributing factors may include weight gain (30), alterations in insulin clearance (31), reduced first-phase insulin secretion (32) and reduced peripheral blood flow due to increased peripheral vascular resistance (33).

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