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Metabolic and Cardiovascular Effects of Carvedilol and Atenolol in Non-Insulin-Dependent Diabetes Mellitus and Hypertension
A Randomized, Controlled Trial
- Dario Giugliano, MD;
- Rita Acampora, MD;
- Raffaele Marfella, MD;
- Nicoletta De Rosa, MD;
- Patrizia Ziccardi, MD;
- Raffaele Ragone, PhD;
- Lorenita De Angelis, MD; and
- Felice D'Onofrio, MD
- From the Second University of Naples, Naples, Italy. Requests for Reprints: Dario Giugliano, MD, via Emilia 1, Afragola (NA), Italy. Current Author Addresses: Drs. Giugliano, Marfella, De Rosa, Ziccardi, and D'Onofrio: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Piazza L. Miraglia, 80138 Naples, Italy.
Abstract
Background: Diabetic patients are considered less suitable than nondiabetic patients for β-blocker therapy because of the risk for worsened glucose and lipid metabolism and more severe hypoglycemic attacks.
Objective: To compare the metabolic and cardiovascular effects of carvedilol with those of atenolol in diabetic patients with hypertension.
Design: Randomized, double-blind, 24-week trial.
Setting: University hospital clinic.
Patients: 45 patients with non–insulin-dependent diabetes mellitus and hypertension.
Intervention: After a 4- to 6-week run-in period during which placebo was given in a single-blind manner, patients were randomly assigned to carvedilol or atenolol.
Measurements: An oral glucose tolerance test; assessment of insulin sensitivity and hormonal responses to insulin hypoglycemia; and assessment of lipid levels, blood pressure, left ventricular mass, and lipid peroxidation.
Results: Changes in systolic and diastolic blood pressure and left ventricular mass index were similar with carvedilol and atenolol (P > 0.2). Fasting plasma glucose and insulin levels decreased with carvedilol and increased with atenolol. Responses to carvedilol were greater than those to atenolol, as follows: increase in total glucose disposal, 9.54 µmol/kg of body weight per minute (95% CI, 7 to 11.9 µmol/kg per minute); decrease in plasma glucose response to oral glucose, 61 mmol/L × 180 minutes (CI, −101 to −21 mmol/L × 180 minutes); decrease in insulin response to oral glucose, 6.2 nmol/L × 180 minutes (CI, −9.8 to −2.6 nmol/L × 180 minutes); decrease in triglyceride level, 0.56 mmol/L (CI, −0.75 to −0.37 mmol/L; P < 0.001); increase in high-density lipoprotein cholesterol level, 0.13 mmol/L (CI, 0.09 to 0.17 mmol/L; P < 0.001); and decrease in lipid peroxidation, 0.25 µmol/L (CI, −0.34 to −0.16µmol/L).
Conclusions: By improving glucose and lipid metabolism and reducing lipid peroxidation, carvedilol may offer advantages in patients with diabetes and hypertension.
- Copyright ©2004 by the American College of Physicians
