First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
Curr Vasc Pharmacol. 2011 Nov;9(6):715-22. doi: 10.2174/157016111797484099.
The majority of individuals with pre-diabetic states eventually appear to develop diabetes mellitus. During the pre-diabetic state, that may last many years, the risk of cardiovascular disease is modestly increased, with impaired glucose tolerance being slightly stronger predictor for future cardiovascular disease than impaired fasting glucose. The role of different antihypertensive drugs in the acceleration or the delay of diabetes onset is controversial. Agents that interrupt the renin-angiotensin system, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers are likely to be beneficial in the prevention of diabetes, while calcium channel blockers are thought to act metabolically neutral. In contrast, diuretics or β-blockers, and especially their combination, are thought to increase the incidence of diabetes. Carvedilol, a non-selective β-blocker with α(1)-blocking properties, and nebivolol, a third-generation highly selective β(1)- blocker with additional endothelial nitric oxide (NO)-mediated vasodilator activity have been shown to have a favorable effect on glucose metabolism compared with others β-blockers. Nevertheless, the key goal still remains to reduce blood pressure, which may require combination of different antihypertensive drug classes. Changes from diuretics and β- blockers to renin-angiotensin system inhibitors certainly have cost implications. However, treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers may be cheaper in the long run, due to less risk of new-onset diabetes and other metabolic disturbances. Thus, for patients with pre-diabetes it is wise to choose medications with the least diabetogenic potential and until more data are available, it seems prudent to restrict use of diuretics and classic β- blockers.
大多数处于糖尿病前期的个体最终似乎都会发展为糖尿病。在糖尿病前期，这可能会持续多年，心血管疾病的风险会适度增加，葡萄糖耐量受损对未来心血管疾病的预测作用略强于空腹血糖受损。不同降压药物在加速或延迟糖尿病发病中的作用存在争议。阻断肾素-血管紧张素系统的药物，如血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂，可能有益于预防糖尿病，而钙通道阻滞剂被认为具有代谢中性作用。相比之下，利尿剂或β受体阻滞剂，尤其是它们的联合使用，被认为会增加糖尿病的发病率。卡维地洛是一种具有α(1)阻断作用的非选择性β受体阻滞剂，而比伐卢定是一种具有内皮型一氧化氮（NO）介导的血管扩张活性的第三代高度选择性β(1)受体阻滞剂，与其他β受体阻滞剂相比，它们对葡萄糖代谢有有利影响。然而，关键目标仍然是降低血压，这可能需要联合使用不同类别的降压药物。从利尿剂和β受体阻滞剂改为肾素-血管紧张素系统抑制剂肯定会产生成本影响。然而，由于新发糖尿病和其他代谢紊乱的风险较低，长期来看，使用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂可能更便宜。因此，对于糖尿病前期患者，明智的做法是选择致糖尿病风险最小的药物，在获得更多数据之前，限制使用利尿剂和经典β受体阻滞剂似乎是谨慎的。
