This weeks
Question:
Can selective beta-blockers be used for people with diabetes and hypertension?
Answer:
1. Yes
2. No
Response
Many of the older beta-blockers have the risk of hypoglycemia and blunting
of hypoglycemic symptoms, but the evidence for this really relates to
older noncardioselective drugs and is in any case not too robust.
All of the studies
of heart disease and stroke protection from beta-blockers show greater
benefit in diabetic patients compared with nondiabetic patients. It
makes sense to avoid these drugs in patients with established hypoglycemia
unawareness, although there is little evidence for this approach. It
should be remembered that prolonged beta-blocker use is associated with
an increased incidence of type 2 diabetes in the hypertensive population,
but whether this represents direct causation remains unclear.
Reference:
Barnett AH, Leslie
D, Watkins PJ. Can insulin-treated diabetics be given beta-adrenergic
blocking drugs? BMJ. 1980;280:976-978.
Cruickshank JM. Beta blockers continue to surprise us. Eur Heart J.
2000;21:354-364.
Kjekshus J, Gilpin E, Cali G, et al. Diabetic patients and beta-blockers
after acute myocardial infarction. Eur Heart J. 1990;11:43-50.
Mykkanen L, Kuusisto J, Pyorala K, et al. Increased risk of non-insulin-dependent
diabetes mellitus in elderly hypertensive subjects. J Hypertens. 1994;12:1425-1432.
Tse WY, Kendall M. Is there a role for beta-blockers in hypertensive
diabetic patients? Diabet Med. 1994;11:137-144.
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