METABOLIC AND CARDIOVASCULAR EFFECTS OF CARVEDILOL AND ATENOLOL IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS AND HYPERTENSION - A RANDOMIZED,CONTROLLED TRIAL

Background: Diabetic patients are considered less suitable than nondia betic patients for p-blocker therapy because of the risk for worsened glucose and lipid metabolism and more severe hypoglycemic attacks. Obj ective: To compare the metabolic and cardiovascular effects of carvedi lol with those of atenolol in diabetic patients with hypertension. Des ign: Randomized, double-blind, 24-week trial. Setting: University hosp ital 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, patien ts were randomly assigned to carvedilol or atenolol. Measurements: An oral glucose tolerance test; assessment of insulin sensitivity and hor monal responses to insulin hypoglycemia; and assessment of lipid level s, blood pressure, left ventricular mass, and lipid peroxidation. Resu lts: Changes in systolic and diastolic blood pressure and left ventric ular mass index were similar with carvedilol and atenolol (P > 0.2). F asting plasma glucose and insulin levels decreased with carvedilol and increased with atenolol. Responses to carvedilol were greater than th ose to atenolol, as follows: increase in total glucose disposal, 9.54 mu mol/kg of body weight per minute (95% CI, 7 to 11.9 mu mol/kg per m inute); decrease in plasma glucose response to oral glucose, 61 mmol/L x 180 minutes (CI, -101 to -21 mmol/L x 180 minutes); decrease in ins ulin response to oral glucose, 6.2 nmol/L x 180 minutes (Cl, -9.8 to - 2.6 nmol/L x 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 lipop rotein cholesterol level, 0.13 mmol/L (CI, 0.09 to 0.17 mmol/L; P < 0. 001); and decrease in lipid peroxidation, 0.25 mu mol/L (CI, -0.34 to -0.16 mu mol/L). Conclusions: By improving glucose and lipid metabolis m and reducing lipid peroxidation, carvedilol may offer advantages in patients with diabetes and hypertension.