Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia.
Int J Obes (Lond). 2011 Nov;35(11):1395-403. doi: 10.1038/ijo.2010.284. Epub 2011 Feb 8.
Sympathetic activation is an important metabolic adaptation limiting weight gain. Propensity of weight gain associated with β-blocker therapy in the obese modern population is unknown.
To determine whether chronic β-blocker therapy reduces energy expenditure (EE) and increases body weight.
We undertook (i) a mechanistic study comparing EE, diet-induced thermogenesis and habitual activity between healthy volunteers (n=11) with uncomplicated hypertension treated with a β-blocker and anthropometrically matched controls (n=19) and (ii) three cross-sectional studies comparing body weight, body mass index (BMI) and waist circumference between β-blocker treated and untreated patients from ambulatory patients attending (a) diabetes outpatient clinic (n=214), (b) hypertension outpatient (n=84) and (c) participants in a multi-centre type 2 diabetes trial (ADVANCE) (n=11140).
Among weight-matched β-blocker users, diet-induced thermogenesis, fat oxidation rate and weekly habitual activity were lower by 50% (P<0.01), 32% (P=0.04) and 30% (P<0.01), respectively, compared with controls. In β-blocker treated patients, the adjusted mean body weight was 9.2 ± 1.2 kg (P=0.0002) higher among those attending the diabetes clinic, 17.2 ± 3.2 kg (P=0.004) higher among those attending the hypertension clinic and 5.2 ± 0.7 kg (P=0.0003) higher at baseline among participants in the ADVANCE trial compared with patients not treated with β-blockers. BMI displayed a similar difference.
EE is reduced and body weight increased in chronic β-blocker users. We hypothesise that chronic β-blockade causes obesity by blunting EE.
交感神经激活是限制体重增加的重要代谢适应。肥胖的现代人群中β受体阻滞剂治疗相关的体重增加倾向尚不清楚。
确定慢性β受体阻滞剂治疗是否会降低能量消耗（EE）并增加体重。
我们进行了（i）一项机制研究，比较了健康志愿者（n=11）和接受β受体阻滞剂治疗的高血压患者（n=19）之间的 EE、饮食诱导产热和习惯性活动，这些患者患有未经复杂治疗的高血压，以及与体重匹配的对照组；（ii）三项横断面研究，比较了接受和未接受β受体阻滞剂治疗的门诊患者的体重、体重指数（BMI）和腰围，这些患者分别来自（a）糖尿病门诊（n=214）、（b）高血压门诊（n=84）和（c）多中心 2 型糖尿病试验（ADVANCE）（n=11140）的参与者。
在体重匹配的β受体阻滞剂使用者中，与对照组相比，饮食诱导产热、脂肪氧化率和每周习惯性活动分别降低了 50%（P<0.01）、32%（P=0.04）和 30%（P<0.01）。在接受β受体阻滞剂治疗的患者中，与未接受β受体阻滞剂治疗的患者相比，在糖尿病门诊就诊的患者中，调整后的平均体重高 9.2±1.2kg（P=0.0002），在高血压门诊就诊的患者中，高 17.2±3.2kg（P=0.004），在 ADVANCE 试验的参与者中，高 5.2±0.7kg（P=0.0003）。BMI 也存在类似差异。
慢性β受体阻滞剂使用者的 EE 降低，体重增加。我们假设慢性β受体阻滞剂阻断会通过降低 EE 导致肥胖。
