Haenni A, Lithell H
Department of Geriatrics, Uppsala University, Sweden.
Metabolism. 1994 Apr;43(4):455-61. doi: 10.1016/0026-0495(94)90076-0.
In a randomized double-blind crossover study in 42 patients with essential hypertension, the metabolic effects of a beta-adrenergic blocker with a pronounced beta 2-agonistic effect, dilevalol 400 mg x 1, were compared with those of metoprolol succinate 200 mg x 1. The effects of glucose metabolism were evaluated by the hyperinsulinemic euglycemic clamp technique and an intravenous glucose tolerance test (IVGTT). Insulin-mediated glucose disposal (M) and the insulin sensitivity index (M/I) increased by 19% (P = .011) and 10% (P = .27), respectively, during dilevalol treatment, but decreased by 10% (P = .15) and 22% (P = .0025), respectively, during metoprolol treatment, giving rise to significant differences between the two treatment regimens. Compared with dilevalol-treated patients, those treated with metoprolol showed increased plasma insulin values at the end of the IVGTT, but there was no difference in plasma glucose concentrations or glucose tolerance. Hemoglobin A1c (HbA1c) levels increased by 5.4% (P = .04) in the metoprolol group. Serum cholesterol, total serum and very-low-density lipoprotein (VLDL) triglycerides, and serum urate levels decreased significantly (by 6%, 22%, 29%, and 14%, respectively) during dilevalol treatment, and there was a significant difference between the effects of the two drugs on total, VLDL, and low-density lipoprotein (LDL) triglyceride and serum urate levels. These data demonstrate that a beta-blocker with a partial beta 2-agonist action differs in its metabolic effect profile from a selective beta 1-blocker and may offer advantages by improving glucose and lipid metabolism.
在一项针对42例原发性高血压患者的随机双盲交叉研究中，比较了具有明显β2激动效应的β肾上腺素能阻滞剂双醋洛尔400毫克×1次与琥珀酸美托洛尔200毫克×1次的代谢效应。采用高胰岛素正常血糖钳夹技术和静脉葡萄糖耐量试验（IVGTT）评估葡萄糖代谢效应。在双醋洛尔治疗期间，胰岛素介导的葡萄糖处置（M）和胰岛素敏感性指数（M/I）分别增加了19%（P = 0.011）和10%（P = 0.27），而在美托洛尔治疗期间分别下降了10%（P = 0.15）和22%（P = 0.0025），导致两种治疗方案之间存在显著差异。与双醋洛尔治疗的患者相比，美托洛尔治疗的患者在IVGTT结束时血浆胰岛素值升高，但血浆葡萄糖浓度或葡萄糖耐量无差异。美托洛尔组糖化血红蛋白（HbA1c）水平升高了5.4%（P = 0.04）。在双醋洛尔治疗期间，血清胆固醇、总血清和极低密度脂蛋白（VLDL）甘油三酯以及血清尿酸水平显著下降（分别下降6%、22%、29%和14%），两种药物对总、VLDL和低密度脂蛋白（LDL）甘油三酯以及血清尿酸水平的影响存在显著差异。这些数据表明，具有部分β2激动作用的β受体阻滞剂在代谢效应方面与选择性β1受体阻滞剂不同，可能通过改善葡萄糖和脂质代谢而具有优势。
