Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy.
Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Università di Milano, via Castelvetro, 32, Milan, 20154, Italy.
Br J Clin Pharmacol. 2021 Aug;87(8):3320-3331. doi: 10.1111/bcp.14754. Epub 2021 Feb 23.
To investigate the statistical association between hypoglycaemia and β-blocker use and to define what patient and drug characteristics could potentially increase the risk for its occurrence.
We investigated the relationship between pharmacological parameters of β-blockers and the occurrence of hypoglycaemia by conducting a case/non case analysis using the Food and Drug Administration Adverse Event Reporting System database. Pharmacological properties that could represent a predictive factor for hypoglycaemia were analysed through a multilinear binary logistic regression (null hypothesis rejected for values of P < .05). We also performed a systematic review of clinical studies on this association.
Of 83 954 selected reports, 1465 cases (1.75%) of hypoglycaemia were identified. The association was found statistically significant for nadolol (reporting odds ratio [95% confidence interval]: 6.98 [5.40-9.03]), celiprolol (2.35 [1.35-4.10]), propranolol (2.14 [1.87-2.46]) and bisoprolol (1.42 [1.25-1.61]). Paediatric cases (n = 310) showed a positive association with hypoglycaemia for long half-life drugs (odds ratio [95% confidence interval]: 2.232 [1.398-3.563]) and a negative association for β1-selectivity (0.644 [0.414-0.999]). Seven papers were included in the systematic review. Because of great heterogeneity in study design and demographics, hypoglycaemia incidence rates varied greatly among studies, occurring in 1.73% of the cases for propranolol treatment (n total participants = 575), 6.6% for atenolol (n = 30) and 10% for carvedilol (n = 20).
Nadolol appears to be the β-blocker significantly most associated with hypoglycaemia and children represent the most susceptible sample. Furthermore, long half-life and nonselective β-blockers seem to increase the risk for its occurrence.
研究低血糖症与β受体阻滞剂使用之间的统计学关联，并确定哪些患者和药物特征可能会增加其发生的风险。
我们通过使用食品和药物管理局不良事件报告系统数据库进行病例/非病例分析，研究了β受体阻滞剂的药理学参数与低血糖症发生之间的关系。通过多线性二元逻辑回归分析（当 P 值<.05 时，拒绝零假设）分析了可能代表低血糖预测因素的药理学特性。我们还对该关联的临床研究进行了系统回顾。
在筛选出的 83954 份报告中，确定了 1465 例（1.75%）低血糖症病例。纳多洛尔（报告比值比[95%置信区间]：6.98[5.40-9.03]）、塞利洛尔（2.35[1.35-4.10]）、普萘洛尔（2.14[1.87-2.46]）和比索洛尔（1.42[1.25-1.61]）与低血糖症的关联具有统计学意义。儿科病例（n=310）显示长半衰期药物与低血糖症呈正相关（比值比[95%置信区间]：2.232[1.398-3.563]），β1-选择性呈负相关（0.644[0.414-0.999]）。系统评价纳入了 7 篇论文。由于研究设计和人口统计学方面的异质性很大，研究之间的低血糖发生率差异很大，普萘洛尔治疗的发生率为 1.73%（n 总参与者=575），阿替洛尔为 6.6%（n=30），卡维地洛为 10%（n=20）。
纳多洛尔似乎是与低血糖症相关性最强的β受体阻滞剂，儿童是最易受影响的样本。此外，半衰期长和非选择性β受体阻滞剂似乎会增加其发生的风险。
