Induction of insulin resistance by beta-blockade but not ACE-inhibition: long-term treatment with atenolol or trandolapril

Abstract

The effects on glucose metabolism by the beta-blocker atenolol and the angiotensin-converting enzyme (ACE)-inhibitor trandolapril were investigated in a randomised double-blind parallel group study of patients with primary hypertension. Twenty-six patients were treated with 50-100 mg atenolol and 27 patients with 2-4 mg trandolapril o.d. Intravenous glucose tolerance tests, euglycaemic hyperinsulinaemic clamps and serum lipid measurements were performed after 8 and 48 weeks of active treatment. After 48 weeks insulin sensitivity was reduced by 23% by atenolol while it remained unchanged during trandolapril treatment (؉0.5%, P ‫؍‬ 0.0010 for difference between treatments, ANCOVA). The effect on triglycerides (؉22% vs ؊8.5%)

Antianginal and Antiischemic Effects of Ivabradine, an I f Inhibitor, in Stable Angina

“…8,16,17 ␤-Blockers may be contraindicated in patients with peripheral vascular disease 18 (which often coexists with coronary artery disease), hypotension, heart block Ͼ1°, 19 or obstructive airway disease 20 and may have adverse effects on lipid and carbohydrate metabolism. [21][22][23][24] A study of patients in primary care with stable angina found that although 64% of patients were taking Ͼ1 cardiovascular drug, angina often was poorly controlled, with a median angina frequency of Ϸ2 per week. 25 Therefore, additional pharmacological antianginal therapy is likely to be useful; specific heart rate-lowering agents plausibly may be particularly helpful.…”

The risk of myocardial infarction is enhanced by a synergistic interaction between serum insulin and smoking

“…Also, it has been suggested that the increased use of betablockers and diuretics can lead to changed IGFBP-1 levels (21) and induction of insulin resistance (22,23). The adjustment for these drugs resulted in a slight decrease in the OR.…”

The Effect of Trandolapril on Insulin Resistance is Determined by the Degree of Baseline Resistance Level

“…Trandolapril was shown to enhance skeletal muscle insulin action and GLUT-4 protein levels in insulin resistant obese rats and it had no effect in insulin sensitive lean rat muscle [19]. In contrast to experimental studies most of the clinical studies conducted indicated that trandolapril has a neutral effect on IR [13][14][15]20]. Only in one clinical study conducted in overweight hypertensive patients with low grade IR trandolapril improved insulin sensitivity moderately compared to nifedipine in the absence of severely obese and diabetic individuals [21].…”