Beta-adrenoblockers in the treatment of hypertension in patients with diabetes mellitus: narrative synthesis of the literature

There is a high incidence of diabetes mellitus in people with hypertension, and the selection of antihypertensive therapy requires careful evaluation of efficacy and safety. Studies have demonstrated, that beta-adrenoblockers reduce total and cardiovascular morbidity and mortality in diabetic hypertensive patients. A narrative review of the literature was performed with the selection and analysis of scientific articles published in the Hinari database, academic literature, regarding the use of beta-adrenoblockers as antihypertensive therapy in diabetic patients. It was revealed, that beta-adrenoblockers possess distinctive pharmacokinetic and pharmacodynamic characteristics, depending on their action on adrenoreceptors and additional effects (nitric oxide release, antioxidant), as well as variable influence on glucidic and lipid metabolism. Thus, non-selective and beta-1-selective beta-adrenoblockers, without vasodilator action, induced weight gain, dysregulation of insulin sensitivity, altered lipid and carbohydrate profile, and a diabetogenic effect with risk of developing de novo diabetes. Beta-adrenoblockers with vasodilatory action (carvedilol, nebivolol) demonstrated neutral or improving effects on lipid profile (↑HDL, ↓LDL), insignificant influence on glycemic control, and antioxidant effect. Beta-adrenoblockers can be used for the treatment of hypertension, especially in patients with cardiovascular comorbidities (arrhythmias, heart failure, coronary artery disease). In patients with hypertension and diabetes mellitus it is recommended to use vasodilatory beta-adrenoblockers (carvedilol, nebivolol), without negative effects on lipid and glucose metabolism, and a low probability of de novo diabetes induction.