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Metabolic and Cardiovascular Effects of Carvedilol and Atenolol in Non-Insulin-Dependent Diabetes Mellitus and Hypertension: A Randomized, Controlled Trial

Dario Giugliano, MD; Rita Acampora, MD; Raffaele Marfella, MD; Nicoletta De Rosa, MD; Patrizia Ziccardi, MD; Raffaele Ragone, PhD; Lorenita De Angelis, MD; and Felice D'Onofrio, MD
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From the Second University of Naples, Naples, Italy. Requests for Reprints: Dario Giugliano, MD, via Emilia 1, Afragola (NA), Italy. Current Author Addresses: Drs. Giugliano, Marfella, De Rosa, Ziccardi, and D'Onofrio: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Piazza L. Miraglia, 80138 Naples, Italy.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(12):955-959. doi:10.7326/0003-4819-126-12-199706150-00004
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Background: Diabetic patients are considered less suitable than nondiabetic patients for β-blocker therapy because of the risk for worsened glucose and lipid metabolism and more severe hypoglycemic attacks.

Objective: To compare the metabolic and cardiovascular effects of carvedilol with those of atenolol in diabetic patients with hypertension.

Design: Randomized, double-blind, 24-week trial.

Setting: University hospital clinic.

Patients: 45 patients with non–insulin-dependent diabetes mellitus and hypertension.

Intervention: After a 4- to 6-week run-in period during which placebo was given in a single-blind manner, patients were randomly assigned to carvedilol or atenolol.

Measurements: An oral glucose tolerance test; assessment of insulin sensitivity and hormonal responses to insulin hypoglycemia; and assessment of lipid levels, blood pressure, left ventricular mass, and lipid peroxidation.

Results: Changes in systolic and diastolic blood pressure and left ventricular mass index were similar with carvedilol and atenolol (P > 0.2). Fasting plasma glucose and insulin levels decreased with carvedilol and increased with atenolol. Responses to carvedilol were greater than those to atenolol, as follows: increase in total glucose disposal, 9.54 µmol/kg of body weight per minute (95% CI, 7 to 11.9 µmol/kg per minute); decrease in plasma glucose response to oral glucose, 61 mmol/L × 180 minutes (CI, −101 to −21 mmol/L × 180 minutes); decrease in insulin response to oral glucose, 6.2 nmol/L × 180 minutes (CI, −9.8 to −2.6 nmol/L × 180 minutes); decrease in triglyceride level, 0.56 mmol/L (CI, −0.75 to −0.37 mmol/L; P < 0.001); increase in high-density lipoprotein cholesterol level, 0.13 mmol/L (CI, 0.09 to 0.17 mmol/L; P < 0.001); and decrease in lipid peroxidation, 0.25 µmol/L (CI, −0.34 to −0.16µmol/L).

Conclusions: By improving glucose and lipid metabolism and reducing lipid peroxidation, carvedilol may offer advantages in patients with diabetes and hypertension.





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