THE ROLE OF VASODILATING BETA-BLOCKERS IN PATIENTS WITH HYPERTENSION AND THE CARDIOMETABOLIC SYNDROME

In the United States, a vast segment of the adult population is classified as having the cardiometabolic syndrome, and currently there are epidemic rates of both type 2 diabetes mellitus and obesity. Hypertension is closely linked with these metabolic disorders and is a strong independent predictor of incident type 2 diabetes. In addition, hypertension is an important contributor to increasing cardiovascular disease risk in patients with the cardiometabolic syndrome. Lowering elevated blood pressure in patients with the cardiometabolic syndrome or diabetes is a critical component of reducing global cardiovascular risk. However, aggressive management of hypertension in these patients is often challenging, and the presence of these conditions is associated with poor blood pressure control. The utility of β-blockers in patients with these conditions continues to be a subject of intense debate, given the adverse metabolic effects associated with conventional β-blockers. Data on vasodilating β-blockers, however, suggest that these agents have favourable or neutral metabolic effects and generally more favourable effects when compared with non-vasodilating members of this class. These agents may expand the utility of β-blockers to patient populations traditionally considered not to be optimal candidates for β-blocker therapy – a fact which has important clinical implications, because more antihypertensive agents are needed to diversify the therapeutic options available for clinicians treating hypertension in patients with the cardiometabolic syndrome or type 2 diabetes.

1. Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. // Diabetes Care. 2005;28:2745-2749.

2. Ballantyne CM. Increasing prevalence of obesity and clustered car-diometabolic risk: can treatment of the underlying cause reverse the trends? //Crit Pathw Cardiol. 2007;6:41-45.

3. Manrique CM, Lastra G, Palmer J, Stump CS, Sowers JR. Hypertension – a treatable component of the cardiometabolic syndrome: challenges for the primary care physician//J Clin Hypertens (Greenwich). 2006;8(suppl 1):12-20.

4. Conen D, Ridker PM, Mora S, Buring JE, Glynn RJ. Blood pressure and risk of developing type 2 diabetes mellitus: the Women’s Health Study//Eur Heart J. 2007;28:2937-2943.

5. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus: Atherosclerosis Risk in Communities Study//N Engl J Med. 2000;342:905-912.

6. Smith SC Jr. Multiple risk factors for cardiovascular disease and diabetes mellitus// Am J Med. 2007;120(suppl 1): S3-S11.

7. Golden SH, Folsom AR, Coresh J, Sharrett AR, Szklo M, Brancati F. Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the Atherosclerosis Risk in Communities Study// Diabetes. 2002;51:3069-3076.

8. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38//BMJ. 1998;317;703-713.

9. Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DR. Long-term follow-up after tight control of blood pressure in type 2 diabetes//N Engl J Med. 2008;359:1565-1576.

10. Kjeldsen SE, Naditch-Brule L, Perlini S, Zidek W, Farsang C. Increased prevalence of metabolic syndrome in uncontrolled hypertension across Europe: the Global Cardiometabolic Risk Profile in Patients with hypertension disease survey//J Hypertens. 2008; 26:2064-2070.

11. Cutler JA, Davis BR. Thiazide-type diuretics and _-adrenergic blockers as first-line drug treatments for hypertension// Circulation. 2008; 117:2691-2705.

12. Chobanian AV, Bakris GL, Black HR, et al, for the National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report// JAMA. 2003;289:2560-2572.

13. С остальными литературными источниками (12-39) можно ознакомиться – cardio.nauka@yandex.ru