Effects of carvedilol versus metoprolol on endothelial function and oxidative stress in patients with type 2 diabetes mellitus
Effects of carvedilol versus metoprolol on endothelial function and oxidative stress in patients with type 2 diabetes mellitus
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DOI：
10.1016/j.amjhyper.2007.01.019
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发表时间：
2007-07-01
影响因子：
3.2
通讯作者：
Gonzalez-Campoy, J. Michael
中科院分区：
文献类型：
--
作者：
Bank, Alan J.;Kelly, Aaron S.;Gonzalez-Campoy, J. Michael
背景：资料显示卡维地洛具有抗氧化特性，可能对血管有保护作用。我们试图在一项头对头试验中比较卡维地洛和酒石酸瑞托洛尔对内皮功能和氧化应激的影响。方法：34例2型糖尿病（T2DM）合并高血压患者，随机分为两组，在现有降压药的基础上分别给予卡维地洛（16例）和美托洛尔（18例）治疗5个月。处理前后分别测量以下变量：血压、空腹血糖和胰岛素、胰岛素抵抗（稳态模型评估）、血红蛋白A1c、血脂、c反应蛋白（CRP）、8-异前列腺素、不对称二甲基精氨酸、氧化LDL胆固醇、超声评估肱动脉血流介导的扩张（FMD）、硝酸甘油诱导的内皮非依赖性扩张（EID）、肱动脉和颈动脉扩张、扩张性和依从性以及颈动脉内膜-中膜厚度（cIMT）。结果：卡维地洛与美托洛尔治疗均可显著降低收缩压（P < 0.05）和舒张压（P < 0.0001）。与美托洛尔比较，卡维地洛显著改善FMD （P < 0.001）。除了高密度脂蛋白胆固醇外，各组之间的血糖或脂质变量均无差异，与卡维地洛组相比，美托洛尔组的高密度脂蛋白胆固醇显著降低（P < 0.05）。CRP、氧化应激标志物、EID、动脉僵硬度或cIMT组间无差异。结论：与美托洛尔相比，卡维地洛能显著改善T2DM患者的内皮功能。血糖控制和氧化应激的改变似乎不能解释观察到的FMD的改善，这表明可能涉及其他机制。Am J Hypertens 2007；[20]中华医学会高血压病杂志，2007。
Background: Data suggest that carvedilol possesses antioxidant properties that might provide vascular protection. We sought to compare the effects of carvedilol and rnetoprolol tartrate on endothelial function and oxidative stress in a head-to-head trial.Methods: Thirty-four patients with type 2 diabetes mellitus (T2DM) and hypertension were randomized to receive either carvedilol (n = 16) or metoprolol (n = 18) in addition to their current anti hypertensive medications for 5 months. The following variables were measured pre-and posttreatment: blood pressure, fasting glucose and insulin, insulin resistance by homeostasis-model assessment, hemoglobin A1c, lipids, C-reactive protein (CRP), 8-isoprostane, asymmetric dimethylarginine, oxidized LDL cholesterol, ultrasound assessment of brachial-artery flow-mediated dilation (FMD), nitroglycerin-induced endothelium-independent dilation (EID), brachial and carotid artery distension, distensibility and compliance, and carotid artery intima-media thickness (cIMT).Results: Both carvedilol and metoprolol treatment resulted in significant and similar decreases in systolic (P < .05) and diastolic (P < .0001) blood pressure. Compared with metoprolol, carvedilol significantly improved FMD (P < .001). No differences between groups were noted for any of the glycemic or lipid variables except for HDL cholesterol, which significantly decreased (P < .05) in the metoprolol group compared with the carvedilol group. No differences were observed between groups for CRP, the markers of oxidative stress, EID, arterial stiffness, or cIMT.Conclusions: Compared with metoprolol, carvedilol significantly improves endothelial function in patients with T2DM. Changes in glycemic control and oxidative stress do not seem to explain the observed improvements in FMD, which suggests that other mechanisms may be involved. Am J Hypertens 2007;20:777-783 (c) 2007 American Journal of Hypertension, Ltd.