April 30, 2012

Better blood pressure-reducing drugs?

A newer version of an old class of blood pressure lowering drugs may offer advantages for obese patients with metabolic syndrome.

Beta-blockers – commonly used to treat hypertension – lower blood pressure and reduce cardiovascular mortality in patients with coronary artery disease and congestive heart failure. But older beta-blockers like metoprolol can worsen glucose balance and inhibit fibrinolysis (the process that breaks down blood clots), which may be problematic for patients with obesity and metabolic syndrome.


Nancy Brown, Hugh J. Morgan Chair in Medicine, and colleagues compared the effects of nebivolol, a third-generation beta-blocker, and metoprolol on glucose balance and markers of fibrinolysis in 46 subjects with metabolic syndrome. They found that the two medicines equivalently reduced blood pressure and heart rate. Metoprolol decreased insulin sensitivity and increased oxidative stress and markers of impaired fibrinolysis, whereas nebivolol lacked these detrimental metabolic effects.

The findings, reported in the April issue of Hypertension, suggest that nebivolol may be preferable for treating hypertension in obese patients with metabolic syndrome. Large-scale clinical trials are needed to fully compare the effects of nebivolol and metoprolol on clinical outcomes in such patients.

This research was supported by a grant from Forest Laboratories, Inc. and by funding through National Institutes of Health grants from the National Heart, Lung and Blood Institute (HL060906) and the National Center for Research Resources (RR024975).