Jacob Stephan, Henriksen Erik J
Department of Endocrinology and Metabolism, Eberhard-Karls-University, Tubingen, Germany.
J Clin Hypertens (Greenwich). 2004 Dec;6(12):690-6; quiz 697. doi: 10.1111/j.1524-6175.2004.03704.x.
Type 2 diabetes and hypertension are both insulin-resistant states that impose an excessive risk burden for future major cardiovascular events, including coronary heart disease, stroke, and heart failure. beta-adrenergic receptor antagonists are effective for the treatment of hypertension, but they are underused in diabetic patients because of possible adverse effects on carbohydrate and lipid metabolism, including insulin resistance, glucose intolerance, and dyslipidemia. Traditional beta blockers, both nonselective and selective, are vasoconstrictive due to unopposed alpha1 activity; however, vasodilating beta blockers are not associated with these negative metabolic effects. This review discusses the background of insulin resistance and its link to diabetes and hypertension, emphasizing the role of vascular control by the renin-angiotensin and sympathetic nervous systems on insulin sensitivity and glucose utilization. Clinical evidence is reviewed for the use of vasodilating beta blockers in the treatment of hypertension and in reducing cardiovascular risk in the diabetic population.
2型糖尿病和高血压均为胰岛素抵抗状态，会给未来发生包括冠心病、中风和心力衰竭在内的重大心血管事件带来过高的风险负担。β-肾上腺素能受体拮抗剂对高血压治疗有效，但由于可能对碳水化合物和脂质代谢产生不良影响，包括胰岛素抵抗、葡萄糖不耐受和血脂异常，在糖尿病患者中未得到充分使用。传统的β受体阻滞剂，无论是非选择性还是选择性的，由于α1活性未被拮抗而具有血管收缩作用；然而，血管舒张性β受体阻滞剂与这些负面代谢效应无关。本综述讨论了胰岛素抵抗的背景及其与糖尿病和高血压的联系，强调肾素-血管紧张素和交感神经系统对血管的控制在胰岛素敏感性和葡萄糖利用方面的作用。综述了血管舒张性β受体阻滞剂用于治疗高血压和降低糖尿病患者心血管风险的临床证据。
