Departments of Medicine, Pharmacology, and Molecular Physiology, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Med. 2010 Jul;123(7 Suppl 1):S21-6. doi: 10.1016/j.amjmed.2010.04.015.
In the United States, a vast segment of the adult population is classified as having the cardiometabolic syndrome, and currently there are epidemic rates of both type 2 diabetes mellitus and obesity. Hypertension is closely linked with these metabolic disorders and is a strong independent predictor of incident type 2 diabetes. In addition, hypertension is an important contributor to increasing cardiovascular disease risk in patients with the cardiometabolic syndrome. Lowering elevated blood pressure in patients with the cardiometabolic syndrome or diabetes is a critical component of reducing global cardiovascular risk. However, aggressive management of hypertension in these patients is often challenging, and the presence of these conditions is associated with poor blood pressure control. The utility of beta-blockers in patients with these conditions continues to be a subject of intense debate, given the adverse metabolic effects associated with conventional beta-blockers. Data on vasodilating beta-blockers, however, suggest that these agents have favorable or neutral metabolic effects and generally more favorable effects when compared with nonvasodilating members of this class. These agents may expand the utility of beta-blockers to patient populations traditionally considered not to be optimal candidates for beta-blocker therapy-a fact which has important clinical implications, because more antihypertensive agents are needed to diversify the therapeutic options available for clinicians treating hypertension in patients with the cardiometabolic syndrome or type 2 diabetes.
在美国，大量成年人群被归类为患有心脏代谢综合征，目前 2 型糖尿病和肥胖的流行率都很高。高血压与这些代谢紊乱密切相关，是 2 型糖尿病发生的强有力的独立预测因素。此外，高血压是增加心脏代谢综合征患者心血管疾病风险的重要因素。降低心脏代谢综合征或糖尿病患者的血压升高是降低全球心血管风险的关键组成部分。然而，这些患者的高血压积极管理往往具有挑战性，而且这些情况与血压控制不佳有关。鉴于传统β受体阻滞剂与不良代谢作用相关，β受体阻滞剂在这些患者中的应用仍然是一个激烈争论的话题。然而，关于血管扩张β受体阻滞剂的数据表明，这些药物具有有利或中性的代谢作用，与该类别的非血管扩张成员相比，通常具有更有利的作用。这些药物可能会将β受体阻滞剂的应用扩展到传统上被认为不是β受体阻滞剂治疗的最佳候选人群的患者群体中——这一事实具有重要的临床意义，因为需要更多的降压药物来多样化治疗患有心脏代谢综合征或 2 型糖尿病的高血压患者的治疗选择。
