Review Antihypertensive treatment with beta-blockers and the spectrum of glycaemic control

Hypertension and type 2 diabetes mellitus (DM) are major cardiovascular risk factors, and often cluster in the same individual in the context of the metabolic syndrome. Management of hyper-tension in the diabetic patient is extremely impor-tant, and agents from all major antihypertensive classes are effective towards this goal. Conventional b-blockers are associated with detrimental effects on insulin sensitivity, glycaemic control, and the incidence of type 2DM and thus are less often used in hypertensive patients with DM. In contrast, the newer vasodilating b-blockers appear to be free of adverse effects on the above metabolic parameters, and could be a valuable tool for hypertension treatment in patients with DM or the metabolic syndrome. This review summarizes the evidence on the effects of antihypertensive treatment with both traditional and vasodilating b-blockers on parameters related to carbohydrate metabolism, and discuss the pathophysiological mechanisms that may be responsible