Published online before print November 14, 2005, doi: 10.1161/01.HYP.0000190585.54734.48
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2005;46:1309.)
© 2005 American Heart Association, Inc.
Original Articles |
Differential Effects of ß-Blockers on Albuminuria in Patients With Type 2 Diabetes
From the Rush University Medical Center (G.L.B.), Chicago, Ill; Tulane University (V.F.), New Orleans, La; St. John’s Hospital (R.E.K.), Springfield, Ill; Washington University School of Medicine (J.B.M.), St. Louis, Mo; St Luke’s Roosevelt Hospital Center (F.M.), New York, NY; Lenox Hill Hospital/New York University (R.A.P.); University of Texas, Dallas (P.R.); Case Western Reserve University (J.T.W.), Cleveland, Ohio; GlaxoSmithKline (B.W., M.A.L., K.M.A.), Philadelphia, Pa; and University of Alabama (D.S.H.B.), Birmingham, Ala.
Correspondence to George L. Bakris, MD, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren St, Suite 470, Chicago, IL 60612. E-mail gbakris{at}earthlink.net
Increases in the cardiovascular risk marker microalbuminuria are attenuated by blood pressure reduction using blockers of the renin-angiotensin system. Such changes in microalbuminuria have not been observed when ß-blockers are used. A prespecified secondary end point of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial was to examine the effects of different ß-blockers on changes in albuminuria in the presence of renin-angiotensin system blockade. Participants with hypertension and type 2 diabetes were randomized to either metoprolol tartrate (n=737) or carvedilol (n=498) in blinded fashion after a washout period of all antihypertensive agents except for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Blinded medication was titrated to achieve target blood pressure, with a-5 month follow-up period. The current analysis examined microalbuminuria, using spot urine albumin:creatinine, in participants who had values at screening and trial end. A greater reduction in microalbuminuria was observed for those randomized to carvedilol (–16.2%
; 95% confidence interval, –25.3, –5.9; P=0.003). Of those with normoalbuminuria at baseline, fewer progressed to microalbuminuria on carvedilol versus metoprolol (20 of 302 [6.6%] versus 48 of 431 [11.1%], respectively; P=0.03). Microalbuminuria development was not related to differences in blood pressure or achievement of blood pressure goal (68% carvedilol versus 67%, metoprolol). Presence of metabolic syndrome at baseline was the only independent predictor of worsening albuminuria throughout the study (P=0.004). ß-Blockers have differential effects on microalbuminuria in the presence of renin-angiotensin system blockade. These differences cannot be explained by effects on blood pressure or 
1-antagonism but may relate to antioxidant properties of carvedilol.
Key Words: diabetes mellitus • metoprolol • hypertension, arterial • morbidity
Related Article:
Hypertension 2005 46: 1254-1255.
This article has been cited by other articles:
 |
|
 |
|
  J. B. McGill Reexamining Misconceptions About {beta}-Blockers in Patients With Diabetes Clin. Diabetes, January 1, 2009; 27(1): 36 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kobori, M. Nangaku, L. G. Navar, and A. Nishiyama The Intrarenal Renin-Angiotensin System: From Physiology to the Pathobiology of Hypertension and Kidney Disease Pharmacol. Rev., September 1, 2007; 59(3): 251 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Stults and R. E. Jones Management of Hypertension in Diabetes Diabetes Spectr, January 1, 2006; 19(1): 25 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ritz Reduction of Microalbuminuria by {beta} Blockers: Beyond Renin-Angiotensin System Blockade Hypertension, December 1, 2005; 46(6): 1254 - 1255. [Full Text] [PDF]
|
|