Gondoni L A, Tagliaferri M A, Titon A M, Nibbio F, Liuzzi A, Leonetti G
Ospedale San Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824 Piancavallo, VB, Italy.
Nutr Metab Cardiovasc Dis. 2003 Aug;13(4):232-7. doi: 10.1016/s0939-4753(03)80016-9.
To evaluate whether chronic treatment with beta-blockers influences resting energy expenditure (REE) and weight loss after a period of diet and physical activity in obese hypertensive patients.
Seventy-eight obese hypertensive patients (24 males and 54 females) aged 53.7 +/- 11.1 years with mean BMI of 42.4 +/- 5.8 kg/m2 were enrolled. Thirty-eight patients were using beta-blockers while 40 patients who had not received beta-blockers in the past 6 months were the control group. REE was measured with indirect calorimetric method. Total body fat mass, total body fat-free mass (FFM) and total body water (W) were determined by bioelectrical impedance analysis. Patients and controls underwent a structured physical training program and a hypocaloric diet for a period of 31.6 +/- 10.6 days. Measured REE in patients taking beta-blockers was 1818 +/- 309 kcal/24 h and 1853 +/- 348 kcal/24 h in patients not taking beta-blockers; p = non significant. Weight and BMI loss were similar between the two groups and were respectively -6.43 +/- 2.62 kg and -2.42 +/- 0.91 kg/m2 in the beta-blocker group and -7.49 +/- 3.10 kg, -2.78 +/- 1.03 kg/m2 in the non beta-blocker group. Body composition was similar in the two groups. In the comparison between patients treated with selective beta 1-adrenoceptors blockers and non selective beta-blockers we found a significant difference in REE (1704 +/- 283 vs 1974 +/- 278; p = 0.012) and in weight loss (-5.6 +/- 2.4 vs -7.5 +/- 2.7; p = 0.048) at the end of study.
Beta-blockers are not associated with a lower REE in obese subjects compared to other antihypertensive treatment. Use of non selective beta-adrenergic blockers is associated with a higher REE and weight loss compared to use of selective beta 1-adrenergic blockers. Non selective beta-blockers could be indicated among first choice drugs in hypertensive severely obese subjects without contraindications to beta-blockade.
评估在肥胖高血压患者进行一段时间的饮食和体育活动后，β受体阻滞剂长期治疗是否会影响静息能量消耗（REE）和体重减轻情况。
纳入78例年龄为53.7±11.1岁的肥胖高血压患者（24例男性和54例女性），平均体重指数（BMI）为42.4±5.8kg/m²。38例患者正在使用β受体阻滞剂，40例在过去6个月未接受β受体阻滞剂治疗的患者作为对照组。采用间接测热法测量REE。通过生物电阻抗分析测定全身脂肪量、全身去脂体重（FFM）和全身水分（W）。患者和对照组接受为期31.6±10.6天的结构化体育训练计划和低热量饮食。服用β受体阻滞剂患者的测量REE为1818±309kcal/24小时，未服用β受体阻滞剂患者为1853±348kcal/24小时；p值无统计学意义。两组间体重和BMI降低情况相似，β受体阻滞剂组分别为-6.43±2.62kg和-2.42±0.91kg/m²，非β受体阻滞剂组为-7.49±3.10kg、-2.78±1.03kg/m²。两组身体成分相似。在比较使用选择性β1肾上腺素能受体阻滞剂和非选择性β受体阻滞剂治疗的患者时，我们发现在研究结束时REE（1704±283 vs 1974±278；p = 0.012）和体重减轻（-5.6±2.4 vs -7.5±2.7；p = 0.048）存在显著差异。
与其他抗高血压治疗相比，β受体阻滞剂在肥胖受试者中与较低的REE无关。与使用选择性β1肾上腺素能受体阻滞剂相比，使用非选择性β肾上腺素能受体阻滞剂与较高的REE和体重减轻相关。在无β受体阻滞剂禁忌证的重度肥胖高血压患者中，非选择性β受体阻滞剂可作为首选药物。
