Beta-Rezeptorenblocker und ACE-Hemmer

Zusammenfassung

Nahezu alle Typ-2-Diabetiker leiden an einer arteriellen Hypertonie, die in der Regel noch vor dem Diabetes manifest wird. Die konsequente Einstellung der arteriellen Hypertonie erfordert häufig eine Zweifachkombination aus Angiotensin Converting Enzyme(ACE)-Hemmer und β-Rezeptorenblocker. Metoprolol ist der häufigste verwendete β-Blocker. Klinische Studien weisen auf eine Überlegenheit von Carvedilol bezüglich der Qualität der Stoffwechseleinstellung und der Vermeidung von Folgestörungen des Diabetes hin. Daher scheint Carvedilol der β-Rezeptorenblocker der Wahl für Patienten mit hohem kardiovaskulären Risiko und insbesondere Typ-2-Diabetiker zu sein. Wegen fehlender Vergleiche zu Metoprolol-Succinat sowie zu optimal dosiertem Metoprolol-Tartrat kann aber nicht von einer sicheren Überlegenheit von Carvedilol ausgegangen werden.

Summary

Nearly all type 2 diabetic patients are suffering from arterial hypertension. The latter usually becomes manifest earlier than the diabetic metabolic disturbances. Adequate treatment often requires a combination of angiotensin converting enzyme(ACE)-inhibitors and β-adrenoceptor antagonists. Metoprolol is still the most frequently used β-adrenoceptor antagonist in this setting. Some clinical trials have shown carvedilol to be superior in improving the metabolic situation and prevention of secondary disorders caused by diabetes. Therefore carvedilol may be the β-adrenoceptor antagonist of choice for treatment of patients at high cardiovascular risk and especially for diabetes type 2. As comparisons to metoprolol succinate as well as to optimally dosed metoprolol tartrate are missing, a definite superiority of carvedilol cannot be assumed.

Schlüsselwörter

Diabetes - arterielle Hypertonie - β-Blocker - Metoprolol - Carvedilol

Key words

diabetes - arterial hypertension - β-adrenoceptor antagonists - metoprolol - carvedilol

Literatur

• 1 Baghestanian M. Stellenwert der Betablocker in der antihypertensiven Therapie von PAVK-Patienten.  Zeitschrift für Gefäßmedizin. 2006;  3 11-16
• 2 Bakris G L, Fonseca V, Katholi R E. et al . Differential effects of beta-blockers on albuminuria in patients with type 2 diabetes.  Hypertension. 2005;  46 1309-1315
• 3 Bakris G L, Fonseca V, Katholi R E. et al . Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial.  JAMA. 2004;  292 2227-2236
• 4 Bell D S. Advantages of a third-generation beta-blocker in patients with diabetes mellitus.  Am J Cardiol. 2004;  93 49B-52B
• 5 Cheng J, Kamiya K, Kodama I. Carvedilol: molecular and cellular basis for its multifaceted therapeutic potential.  Cardiovasc Drug Rev. 2001;  19 152-171
• 6 Giugliano D, Acampora R, Marfella R. et al . Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial.  Ann Intern Med. 1997;  126 955-959
• 7 Kindermann M, Maack C, Schaller S. et al . Carvedilol but not metoprolol reduces beta-adrenergic responsiveness after complete elimination from plasma in vivo.  Circulation. 2004;  109 3182-3190
• 8 Kurtz T W, Pravenec M. Antidiabetic mechanisms of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists: beyond the renin-angiotensin system.  J Hypertens. 2004;  22 2253-2261
• 9 Kveiborg B, Christiansen B, Major-Petersen A, Torp-Pedersen C. Metabolic effects of beta-adrenoceptor antagonists with special emphasis on carvedilol.  Am J Cardiovasc Drugs. 2006;  6 209-217
• 10 McBride, White C M. Critical differences among beta-adrenoreceptor antagonists in myocardial failure: debating the MERIT of COMET.  J Clin Pharmacol. 2005;  45 6-24
• 11 McTavish D, Campoli-Richards D, Sorkin E M. Carvedilol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy.  Drugs. 1993;  45 232-258
• 12 Morgan T. Clinical pharmacokinetics and pharmacodynamics of carvedilol.  Clin Pharmacokinet. 1994;  26 335-346
• 13 Poole-Wilson P A, Swedberg K, Cleland J G. et al . Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial.  Lancet. 2003;  362 7-13
• 14 Segura J, Ruilope L M. Antihypertensive therapy in patients with metabolic syndrome.  Curr Opin Nephrol Hypertens. 2006;  15 493-497
• 15 Stahl E, Henke D, Mutschler E, Spahn-Langguth H. Saturable enantioselective first-pass effect for carvedilol after high oral racemate doses in rats.  Arch Pharm (Weinheim). 1993;  326 123-125
• 16 Stoschitzky K, Koshucharova G, Lercher P. et al . Stereoselective effects of (R)- and (S)-carvedilol in humans.  Chirality. 2001;  13 342-346
• 17 Stoschitzky K, Koshucharova G, Zweiker R. et al . Differing beta-blocking effects of carvedilol and metoprolol.  Eur J Heart Fail. 2001;  3 343-349