BETA-BLOCKERS
FOR THE TREATMENT OF HYPERTENSION IN PATIENTS WITH DIABETES: EXPLORING THE
CONTRAINDICATION MYTH.
Majumdar
SR. Cardiovasc Drugs Ther 1999 Sep;13(5):435-9.
PURPOSE:
To review the evidence supporting the "contraindications"
(hypoglycemic unawareness, insulin resistance, and dyslipidemia) usually given
as the reasons for not using beta blockers for treating hypertension in
patients with diabetes mellitus.
METHODS:
A research synthesis based on MEDLINE (January 1966 through January 1999), hand
searches of pertinent references and textbooks, and consultation with experts.
RESULTS:
There is little evidence to support the assertion that beta blockers should be
routinely contraindicated in diabetes. Beta blockers have few clinically
important effects on hypoglycemic awareness and recovery, insulin resistance
and hyperglycemia, or lipid profiles. Moreover, when diabetics have been
treated with beta blockers for hypertension or for the secondary prevention of
myocardial infarction, they benefit as much, if not more, than nondiabetic
patients. There may be circumstances (e.g., hypertensive patients with coronary
disease) under which beta blockers are the drugs of first choice for diabetic
patients. Recommendations to use agents other than beta blockers for the
treatment of hypertension in diabetes are based on these agents' effectiveness
against surrogate endpoints, and not their proven benefit in preventing
important clinical endpoints.
CONCLUSIONS:
Except for patients with brittle glycemic control, manifest hypoglycemic
unawareness, renal parenchymal disease, or documented intolerance, beta
blockers should no longer be considered routinely contraindicated in the
presence of diabetes.